Abstract

Vestibular neuritis presents as a sudden onset of rotary vertigo with associated nausea, vomiting, and generalized imbalance. In general, the dizziness lasts from a few hours to several days with gradual, definite improvement throughout the course. Vestibular neuritis is now considered to be the more accurate term for cases that do not involve hearing loss. The diagnosis of vestibular neuritis depends on the history of spontaneous, prolonged vertigo, physical findings that are consistent with a unilateral peripheral vestibular paralysis, and the absence of other neurological symptoms and signs. History and physical examination alone are usually adequate for diagnosis, although one must ensure that a central insult is not at fault. Relevant differential diagnoses are pseudo-vestibular neuritis due to acute pontomedullary brainstem lesions or cerebellar nodular infarctions, vestibular migraine, sudden sensorineural hearing loss accompanies vertigo with a vestibular neuritis-like pattern and monosymptomatically beginning Meniere's disease. Vestibular function tests including caloric test, vestibular evoked myogenic potential are useful to identify the side of involvement and to localize the pathology to the inferior or superior vestibular nerve.