DIZZINESS-VESTIBULAR NEURONITIS
SUMMARY
1. Vestibular neuronitis (acute peripheral vestibulopathy) causes a sudden onset of non-positional vertigo (assoc. with nausea & vomiting) that is self-limited, may last weeks to months and recur.
2. Caused by an acute peripheral vestibular process most commonly due to reactivation of latent herpes simplex virus in the vestibular ganglion[1]
2. Robinson DA, Zee DS, Hain TC, et al. Alexander’s law: its behavior and origin in the human vestibulo-ocular reflex. Ann Neurol 1984;16(6):714Y722. doi:10.1002/ana.410160614.
3. Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67(10):1870Y1871. doi:10.1212/ 01.wnl.0000244473.84246.76.
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3. Pure vestibular neuritis does not affect hearing, whereas vestibular labyrinthitis does.
4. Abrupt onset and lasts for days (differentiates it from Meniere disease, which usually subsides within 8 hrs).
5. Causes spontaneous horizontal nystagmus, the direction of nystagmus does not change with changing the direction of gaze.
6. Alexander law: nystagmus fast phase (beats away from the affected ear) increases during gaze in the direction of the fast phase and diminishes or abates with gaze away from the fast phase[2]
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7. Symptomatic treatment with anti-histamines/vestibular suppressants which may reduce symptoms. Recurs at 2% over a lifetime[3]
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Reference(s)
- ↑ Jeong SH, Kim HJ, Kim JS. Vestibular neuritis. Semin Neurol 2013;33(3):185Y194. doi:10.1055/s-0033-1354598.
- ↑ Robinson DA, Zee DS, Hain TC, et al. Alexander’s law: its behavior and origin in the human vestibulo-ocular reflex. Ann Neurol 1984;16(6):714Y722. doi:10.1002/ana.410160614.
- ↑ Huppert D, Strupp M, Theil D, et al. Low recurrence rate of vestibular neuritis: a long-term follow-up. Neurology 2006; 67(10):1870Y1871. doi:10.1212/ 01.wnl.0000244473.84246.76.
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].
