Vestibular neuritis

Vestibular neuritis or vestibular neuronitis is characterized by the sudden onset of spinning vertigo and nausea in a patient. The vertigo and dizziness can last a few days and is accompanied by imbalance, sweating and vomiting. It is believed that the herpes simplex type 1 (HSV-1) or cold sore virus attacks the vestibular nerve of the inner ear and causes the condition. A viral cause is supported due to the fact that vestibular neuritis often follows a after a viral upper respiratory tract infection, often occur in spring and early summer and may affect more than one family member.  However it is not recommended to perform blood tests for viruses since a positive finding does not prove a causal relation between the specific virus and the vestibular neuritis. When walking, patients tend to veer to a specific side. Hearing is not affected. With examination the patient demonstrates findings that fit in with a weak vestibular system on the one side. Neurological symptoms and signs should be excluded because in rare cases a condition in the brain can mimic vestibular neuritis. This is referred to as pseudo neuritis.  The patient usually displays nystagmus (repetitive involuntary jerking eye movements). Initial management with medication includes vestibular suppressants, anti nausea medication, anti virals, betahistine and steroids. Depending on the severity of the damage to the nerve, it can take weeks to recover. After the acute stage of vertigo and nausea has settled vestibular rehabilitation exercises are indicated. Medication should not be used for more than a few days as it may impair the recovery.  Vestibular rehabilitation exercises aim to help the brain to compensate for the lesion. It should be performed every day, preferably more than once and is expected to cause some dizziness for the patient. This is a good sign. In rare cases it can recur.

Vestibular neuritis

Vestibular neuritis