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Vestibular Neuronitis

by Lawrence R. Lustig, MD

Vestibular neuronitis causes a self-limited episode of vertigo, presumably due to inflammation of the vestibular division of the 8th cranial nerve; some vestibular dysfunction may persist.

Although etiology is unclear, a viral cause is suspected.

Symptoms and Signs

Symptoms include a single attack of severe vertigo, with nausea and vomiting and persistent nystagmus toward the affected side, which lasts 7 to 10 days. The nystagmus is unidirectional, horizontal, and spontaneous, with fast-beat oscillations in the direction of the unaffected ear. The absence of concomitant tinnitus or hearing loss is a hallmark of vestibular neuronitis. The condition slowly subsides over days to weeks after the initial episode. Some patients have residual dysequilibrium, especially with rapid head movements, probably due to permanent vestibular injury.

Diagnosis

  • Audiology, electronystagmography, and MRI

Patients undergo an audiologic assessment, electronystagmography with caloric testing, and gadolinium-enhanced MRI of the head, with attention to the internal auditory canals to exclude other diagnoses, such as cerebellopontine angle tumor, brain stem hemorrhage, or infarction. MRI may show enhancement of the vestibular nerves, consistent with inflammatory neuritis.

Treatment

  • Symptom relief with antiemetics, antihistamines, or benzodiazepines

Symptoms are symptomatically addressed over the short term as in Meniere disease (see Meniere Disease : Treatment), ie, with anticholinergics, antiemetics (eg, prochlorperazine or promethazine 25 mg rectally or 10 mg po q 6 to 8 h), antihistamines or benzodiazepines, and a corticosteroid burst with rapid taper. If vomiting is prolonged, IV fluids and electrolytes may be required. Long-term use (ie, for more than several weeks) of vestibular suppressants is highly discouraged because these drugs prolong vestibular compensation, particularly in the elderly. Vestibular rehabilitation (usually given by a physical therapist) helps compensate for any residual vestibular deficit.

Key Points

  • Patients have severe, constant vertigo with nausea and vomiting and nystagmus towards the affected side.

  • There is no hearing loss or tinnitus.

  • Testing is done to exclude other disorders.

  • Treatment is directed at symptoms and includes antiemetics and antihistamines or benzodiazepines; corticosteroids may also be helpful.

Drugs Mentioned In This Article

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  • COMPRO
  • PROMETHEGAN

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