Vestibular Neuritis (Neuronitis)

Some sources consider vestibular neuritis and labyrinthitis to be the same thing (some differentiate based on auditory symptoms)

Background

Benign, self-limited disorder associated with complete recovery in most patients
- Must distinguish from acute vascular lesions of the CNS
Pathophysiology
- May be viral or postviral inflammatory disorder affecting vestibular portion of CN VIII
May differentiate from labyrinthitis which technically should have hearing loss

Acute, rapid onset of severe vertigo with nausea/vomiting and gait instability
Nystagmus
- Unilateral, horizontal or horizontal-torsional that is suppressed with visual fixation
- Does not change direction with gaze
Unlike BPPV and Meniere lasts several days and does not recur

Cerebellum lesion
- Nystagmus
  - Not suppressed with visual fixation
  - May be other than horizontal or horizontal-torsional
  - May change direction with gaze
- Ataxia
- Patient may have limb dysmetria, dysarthria, or headache
- Head impulse test usually normal
Brainstem infarction
- Usually associated with other symptoms of Wallenberg syndrome (lateral medulla infarct)
  - Ipsilateral Horner's, loss of corneal reflex, dysphagia, contralateral loss of pain/temp

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