Vestibular neuronitis

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Vestibular neuronitis
ICD-10 H81.2
ICD-9 386.12

Vestibular Neuronitis, also called Vestibular neuritis, can be a paroxysmal, single attack of vertigo, a series of attacks, or a persistent condition which diminishes over two weeks. It may be associated with nausea, vomiting, and previous upper respiratory tract infections. It generally has no auditory symptoms, unlike labyrinthitis. Vestibular neuronitis may also be associated with eye nystagmus. It is caused by inflammation of the vestibular nerve, the nerve that connects the inner ear to the brain.

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Acute onset Recurrency Nystagmus Hearing problems
Peripheral
BPPV
[1][2][3]
+ + +/−
Vestibular neuritis
[4]
+ +/− + /−

(unilateral)

  • + Head thrust test
HSV oticus
[5][6][7][8]
+ +/− +/− + VZV antibody titres
Meniere disease
[9][10]
+/− + +/− + (Progressive)
Labyrinthine concussion
[11][12]
+ +
Perilymphatic fistula
[13][14][15]
+/− + +
  • CT scan may show fluid around the round window recess
Semicircular canal

dehiscence syndrome
[16][17]

+/− + +

(air-bone gaps on audiometry)

Vestibular paroxysmia
[18][19][20]
+ + +/−

(Induced by hyperventilation)

Cogan syndrome
[21][22][23]
+ +/− + Increased ESR and cryoglobulins
  • In CT scan we may see calcification or soft tissue attenuation obliterating the intralabyrinthine fluid spaces
Vestibular schwannoma
[24][25]
+ +/− +
Otitis media
[26][27]
+ +/− Increased acute phase reactants
Aminoglycoside toxicity
[28]
+ +
Recurrent vestibulopathy
[29][30]
+
  • It may happen infrequently, every one to two years
  • It may be associated with nausea and vomiting
  • It may overlap with vestibular migraine
Central
Vestibular migrain
[31][32]
+ +/− +/−
  • ICHD-3 criteria
Epileptic vertigo
[33]
+ +/−
  • They response well to anti-seizure drugs
Multiple sclerosis
[34][35][36]
+ +/− Elevated concentration of CSF oligoclonal bands
  • MS is at least two times more common among women than men
  • The onset of symptoms is mostly between the age of fifteen to forty years, rarely before age fifteen or after age sixty
Brain tumors
[37]
+/− + + + Cerebral spinal fluid (CSF) may show cancerous cells
  • On CT scan most of the brain tumors appears as a hypodense mass lesions
  • On MRI most of the brain tumors appears as a hypointense or isointense on T1-weighted scans, or hyperintense on T2-weighted MRI.
Cerebellar infarction/hemorrhage + ++/−
  • Based on the time interval between stroke and imaging we may have different presentations
Brain stem ischemia + +/−
  • Based on the time interval between stroke and imaging we may have different presentations
  • For more information click here
Chiari malformation
[38][39]
+ +
  • Patient may experience ringing in the ears
Parkinson
[40][41][42]
+

ABBREVIATIONS

VZV= Varicella zoster virus, MRI= Magnetic resonance imaging, ESR= Erythrocyte sedimentation rate, EEG= Electroencephalogram, CSF= Cerebrospinal fluid, GPe= Globus pallidus externa, ICHD= International Classification of Headache Disorders

External links

hr:Vestibularni neuronitis

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