Vestibular neuritis, also known as acute unilateral vestibulopathy (AUVP), refers to the situation where there inflammation of the vestibular nerve/vestibulocochlear nerve. It can be associated with labyrinthitis.
The vestibular nerve is a large division of cranial nerve eight (CN VIII) that transfers the equilibrium information from the inner ear to the central nervous system. The cochlear nerve is the other large branch of the vestibulocochlear nerve that transports the sounds findings to the central nervous system. Inflammation of the vestibular branch of CN VIII (vestibulitis) is associated with the vertigo symptoms.
On the other hand, swelling of both vestibular and cochlear nerve bundles (labyrinthitis) produce tinnitus and/or hearing problems moreover to vertigo.
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Epidemiology
Some consider this being the third most common cause of peripheral vestibular vertigo. It has an estimated annual incidence of 3.5 per 100,000 population and may account for 7% of patients at outpatient clinics specializing in the treatment of vertigo 7.
Vestibular neuritis is common between men and women aged 30-60 years old group and increased the incidence of it's with the aging regarding the decreased in the number of inner ears nerve cells and blood flow 1,2.
Clinical presentation
Some patients may give a history of a prodromal gastrointestinal or upper respiratory tract infection, especially in men and women aged 30-60 years old 1,2.
Otherwise, the syndrome presents typically 2:
vertigo (sudden and severe)
spotnaneous horizontal nystagmus, fast phase beats away from the affected side (Alexander's law)
balance/gait difficulty
nausea and vomiting
concentration problems
After recovery of the symptoms, balance and dizziness disorders can last for several months in some of the patients.
Pathology
Preferentially, the superior division of the vestibular nerve is affected, which leads to involvement of the superior and horizontal semicircular canals, however, both divisions can also be commonly affected concurrently 7. Viral infections are the commonest causes of the vestibular neuritis and bacterial infections are much less common. Most common types of viral causes of vestibular neuritis include herpes simplex (HSV-1) infection considered most common viral etiology 2), measles, rubella, mump, Epstein Barr, flu, herpes zoster, and chickenpox.
Radiographic features
MRI with contrast is sometimes requested by clinicians in order to rule out of the other causes of sudden onset dizziness and vertigo such as stroke (especially AICA territory strokes) and brain tumors.
MRI
T1 C+ (Gd): can show enhancement of the vestibular nerve fibers within the internal auditory canal with the labyrinth of the inner ear often intact
Treatment and prognosis
Corticosteroids, antiemetics and vestibular physiotherapy are standard supportive measures of care 2. No antiviral or antibacterial therapy is usually necessary. Recurrence is rare and most patients will show full recovery.
Differential diagnosis
isolated nodular ischemic stroke 3
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