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Vestibular Neuritis 

Vestibular Neuritis

Michael Strupp

and Thomas Brandt


The key signs and symptoms of vestibular neuritis are acute onset of rotatory vertigo lasting several days, horizontal-rotatory peripheral vestibular spontaneous nystagmus toward the unaffected ear, a pathological head-impulse test, tilt of the subjective visual vertical, postural imbalance with falls - all toward the affected ear - and nausea. The head-impulse test and caloric irrigation show an ipsilateral deficit of the vestibulo-ocular reflex. Vestibular neuritis is the third most common cause of peripheral vestibular vertigo. It has an annual incidence of 3.5 per 100,000 persons and accounts for 7% of the patients at outpatient clinics specializing in the treatment of vertigo. Reactivation of a latent herpes simplex virus type 1 (HSV-1) infection is the most likely cause, particularly since HSV-1 DNA, RNA, and the latency-associated transcript have been detected in human vestibular ganglia. The diagnosis of vestibular neuritis is a diagnosis of exclusion. Relevant differential diagnoses are “vestibular pseudoneuritis” due to acute pontomedullary brainstem lesions or cerebellar infarctions, vestibular migraine, and monosymptomatic early Menière’s disease. Recovery from vestibular neuritis is due to a combination of the following: first, peripheral restoration of labyrinthine function, usually incomplete but improvable by early treatment with corticosteroids, which cause a recovery rate of 62% within 12 months; second, mainly somatosensory and visual substitution which, however, cannot replace the dynamic deficit of the vestibulo-ocular reflex; and third, central compensation, which is promoted by vestibular exercises.

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