Vestibular Neuritis

Aka: Vestibular Neuritis, Acute Vestibular Neuronitis, Epidemic Vertigo

1. Epidemiology
   1. Second most common peripheral cause of Vertigo
   2. May occur in several family members (Epidemic Vertigo)
2. Pathophysiology
   1. Distinct entity - not synonymous with labyrinthitis
   2. Inflammation and degeneration of Vestibular nerve
   3. Associated with viral infections
      1. Herpesviruses
      2. Borrelia
3. Symptoms
   1. Vertigo lasting days to weeks
   2. Spontaneous onset and provoked by rapid head movements
      1. Not consistently provoked by head position changes
      2. May persist for months after acute disease resolves
   3. Sense of imbalance
   4. Nystagmus is variably present
   5. Loss of respose to Cold Calorics (consistent finding)
   6. No Tinnitus
   7. No Hearing Loss
4. Differential Diagnosis
   1. See Vertigo Causes
   2. Provoked by head position
      1. Benign Paroxysmal Positional Vertigo
      2. Acute Labyrinthitis (associated with Tinnitus)
   3. Not provoked by head position
      1. Meniere's Disease (associated with Hearing Loss)
5. Management
   1. See Vertigo Management
   2. Supportive
      1. Meclizine (Antivert) 12.5 to 25 mg PO tid-qid
   3. Severe Symptoms
      1. Corticosteroids
         1. Prednisone taper 5mg PO 7 tabs daily to 1 tab daily
         2. Effective in improving vestibular function
            1. Started Methylprednisolone (22 day) within 3 days
            2. Strupp (2004) N Engl J Med 351:354-61
      2. Phenergan as needed for 3 to 5 days
      3. Diazepam (Valium) 5 mg orally q6 hours for 3 days
   4. Measures shown not to be effective
      1. Valacyclovir is not effective
6. Course
   1. Self limited, acute illness resolves within 1 week
   2. Postural Vertigo may be residual for weeks
   3. Consider Serial Audiogram
7. References
   1. Schessel in Cummings (2005) Otolaryngology p. 3231-2
   2. Labuguen (2006) Am Fam Physician 73:244-54