Vestibular Neuritis


Vestibular neuritis is an acute peripheral (inner ear nerve) vestibular disease caused by inflammation of the inner ear nerve (cranial nerve VIII) that travels from the inner ear to the brainstem.  This results in a reduction in vestibular system input from one side, what we call an acute peripheral 
unilateral vestibulopathy.  Typical symptoms include the fairly sudden onset of vertigo and often vomiting, which lasts hours to days.  There is often a preceding viral illness.  Dizzy symptoms slowly improve over weeks to months and most patients will completely recover from this condition.  

In the first several days of onset of symptoms, medications including meclizine, phenergan and diazepam may be useful.  However, it is best to stop using these medication as soon as possible (3-7 days) as continuing to take these medications will reduce your brain's ability to compensate for the damaged nerve.  Prednisone, tapering over 7-10 days,  has been shown to be useful in reducing symptom severity and duration in the early stages.  The use of anti-virals has not been proven to be helpful, but many experts believe that if the anti-viral medication is started in the first 24 hours of onset of symptoms, then symptom severity and duration might be reduced.

Recovery is enhanced by vestibular rehabilitation, where specific exercises stimulate centers in the brain to adapt and adjust to compensate for the damaged nerve.  We call this 'central compensation'. 



The video below is of a patient suffering from left vestibular neuritis.  You will see a right-beating nystagmus which follows Alexander's Law, meaning that the amount of nystagmus increases in gaze in the same direction of the nystagmus (right) and decreases in gaze opposite the direction of nystagmus (left).  A decrease in nystagmus with fixation (staring at a light) is also a finding noted with a peripheral (inner ear) abnormality.

Nystagmus Pattern in Left Vestibular Neuritis
 
 
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