Vestibular neuritis

The key signs and symptoms of vestibular neuritis are rotatory vertigo with an acute onset lasting several days, horizontal spontaneous nystagmus (with a rotational component) toward the unaffected ear, a pathologic head-impulse test toward the affected ear, a deviation of the subjective visual vertical toward the affected ear, postural imbalance with falls toward the affected ear, and nausea. The head-impulse test and caloric irrigation show an ipsilateral deficit of the vestibuloocular reflex. Vestibular neuritis is the third most common cause of peripheral vestibular vertigo. It has an annual incidence of 3.5 per 100,000 population and accounts for 7% of the patients at outpatient clinics specializing in the treatment of vertigo. The reactivation of a latent herpes simplex virus type 1 (HSV-1) infection is the most likely cause, as HSV-1 DNA and RNA have been detected in human vestibular ganglia. Vestibular neuritis is a diagnosis of exclusion. Relevant differential diagnoses are vestibular pseudoneuritis due to acute pontomedullary brainstem lesions or cerebellar nodular infarctions, vestibular migraine, and monosymptomatically beginning Ménière's disease. Recovery from vestibular neuritis is due to a combination of (a) peripheral restoration of labyrinthine function, usually incomplete but can be improved by early treatment with corticosteroids, which cause a recovery rate of 62% within 12 months; (b) mainly somatosensory and visual substitution; and (c) central compensation, which can be improved by vestibular exercise.