Vestibular Neuritis

Question 1

Vestibular neuritis is a condition that affects the vestibular nerve, which connects the inner ear to the brain. What is the Incidence of this?

1 - 400 cases per 100,000
2 - 40 cases per 100,000
3 - 4 cases per 100,000
4 - 0.4 cases per 100,000

Answer 1

3 - 4 cases per 100,000

Affects men an women equally

Question 2

Vestibular neuritis is a condition that affects the vestibular nerve, which connects the inner ear to the brain. What age does incidence typically peak?

1 - 60-70
2 - 40-50
3 - 20-30
4 - 10-20

Answer 2

2 - 40-50

Question 3

Which of the following is NOT a component of the vestibular system?

1 - cochlea nerve
2 - vestibular nerve
3 - semi-circular canals
4 - otolith organs (utricle and saccule)

Answer 3

1 - cochlea nerve

Semi-circular canals = head rotation
Sacule = linear motion (gravity)
Utricle = horizontal motion

Question 4

What is the most common cause of Vestibular neuritis?

1 - bacterial infection
2 - trauma
3 - viral infection
4 - idiopathic

Answer 4

3 - viral infection

Herpesviruses, such as herpes simplex virus (HSV) and varicella-zoster virus (VZV) are common

Upper respiratory tract infections

Causes inflammation of the vestibular nerve

Question 5

Patients with vestibular neuritis typically present with all of the following, EXCEPT which one?

1 - diplopia
2 - sudden onset vertigo
3 - imbalance
4 - nystagmus
5 - nausea and vomiting

Answer 5

1 - diplopia

Patients often report a sense of unsteadiness or imbalance, which may lead to difficulties walking or performing daily activities.

Question 6

Patients with vestibular neuritis typically present with:

• sudden onset vertigo
• imbalance
• nystagmus
• nausea and vomiting

Hearing loss is not normal, but if hearing loss does occur, what is this called?

1 - menieres disease
2 - labyrinthitis
3 - otitis media with effusion
4 - cholestaemia

Answer 6

2 - labyrinthitis

This is because the whole labyrinths system is likely to be involved

Question 7

Patients with vestibular neuritis typically present with sudden onset of vertigo. How long does this typically last for?

1 - minutes to hours
2 - hours to days
3 - days to weeks
4 - years

Answer 7

3 - days to weeks

Can vary, but typically can last days to weeks.

Symptoms are more severe in first few days

Question 8

Once a patient has developed vestibular neuritis they will have sudden onset of vertigo that is most severe in the first few days. Does this remain constant after the first few days?

Answer 8

• No

Typically triggered, or worsened by head movement

Question 9

Patients with vestibular neuritis can present with nystagmus. Is this unidirectional, bidirectional or vertical?

Answer 9

• unilateral

Everything else would suggest a central issue instead of a vestibular nerve issue

Question 10

Do patients with vestibular neuritis typically experience tinnitus or hearing loss?

Answer 10

• no

Cochlea is unaffected so they dont experience these symptoms

Question 11

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. If the patient is able to maintain their gaze on your nose is this a central or peripheral problem?

Answer 11

• central
• indicates that the vestibulocochlear nerve is NOT damaged

Question 12

The head impulse, nystagmus and test of skew (HINTS) is used to distinguish between a central or peripheral cause of ongoing vertigo. The 1st test is the head impulse test (HIT):

1 - patient fixes their eyes on your nose 2 - head is rapidly rotated 30 degrees to left and then back to midlife
3 - patient either maintains gaze on nose or fails to do so.
4 - repeat and rotate head to right

If they are unable to maintain a fixed gaze, this is called a corrective saccade. Is this a central or peripheral problem?

Answer 12

• peripheral

Suggests that there is an issue with vestibulocochlear

Both vestibular neuritis and labyrinthitis will cause a corrective saccade.

Question 13

The 1st part of head impulse, nystagmus and test of skew (HINTS) is the head impulse test (HIT). If the patient is unable to maintain a fixed gaze, this is called a corrective saccade. suggesting a peripheral problem. Does this occur in both directions or just one?

Answer 13

• unilateral only

Question 14

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). Which of the following are true about the nystagmus aspect of the HINTS examination?

1 - unidirectional nystagmus is more likely to be of peripheral origin
2 - change in nystagmus direction is likely to be associated with central pathologies
3 - bidirectional nystagmus, is highly specific for stroke
4 - all of the above

Answer 14

4 - all of the above

Question 15

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a unidirectional nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 15

• peripheral

Indicates vestibulocochlear issue

Question 16

The nystagmus test is the 2nd part of the head impulse, nystagmus and test of skew (HINTS). If a patient has a bidirectional or vertical nystagmus, and its always in the same direction, is this due to a peripheral or central cause?

Answer 16

• central cause

bidirectional nystagmus, is highly specific for stroke

Question 17

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = corrective saccade
2nd part = unidirectional nystagmus
3rd part = normal test of skew

Is this a central or peripheral issue?

Answer 17

• peripheral

Most likely vestibular neuritis and patient can be discharged

Question 18

If you perform the 3 parts of the head impulse, nystagmus and test of skew (HINTS) exam and have the following:

1st part = normal reflex
2nd part = vertical/bidirectional nystagmus
3rd part = abnormal test of skew

Is this a central or peripheral issue?

Answer 18

• central

More serious issue and needs more investigations

Question 19

Which 2 of the following present in a similar way to vestibular neuritis, but also have tinnitus and hearing loss associated with them?

1 - labyrinthitis
2 - migraine
3 - optic neuritis
4 - menieres disease

Answer 19

1 - labyrinthitis
4 - menieres disease

Question 20

Which of the following patients may need admission with vestibular neuritis?

1 - severe vertigo and imbalance
2 - severe nausea and vomiting
3 - diplopia associated with vertigo
4 - all of the above

Answer 20

2 - severe nausea and vomiting

May cause AKI and need fluids

Question 21

Patients with vestibular neuritis can be treated with all of the following, EXCEPT which one?

1 - metoclopramide
2 - cyclizine
3 - cinnarizine
4 - promethazine

Answer 21

1 - metoclopramide

All others are H1 receptor blocker antihistamines

Use for 3 days, as longer may worse the recovery

Question 22

Patients with vestibular neuritis can be treated with which of the following?

1 - Haloperidol
2 - Chlorpromazine,
3 - Prochlorperazine
4 - Olanzapine,

Answer 22

3 - Prochlorperazine

Typical anti-psychotic

Use for 3 days, as longer may worse the recovery

Question 23

When should patients with vestibular neuritis be referred to an ENT/neurology specialist?

1 - severe vertigo and imbalance
2 - severe nausea and vomiting
3 - diplopia associated with vertigo
4 - no improvement in symptoms after 1 week

Answer 23

4 - no improvement in symptoms after 1 week

Question 24

Which of the following is most likely to develop following vestibular neuritis?

1 - labyrinthitis
2 - migraine
3 - benign paroxysmal positional vertigo
4 - menieres disease

Answer 24

3 - benign paroxysmal positional vertigo

Question 25

A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms. How long do the vertigo symptoms typically last?

1 - seconds to minutes
2 - minutes to hours
3 - hours to days
4 - days to weeks

Answer 25

2 - minutes to hours

Question 26

A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. Patients that experience vestibular migraine are also likely to experience which of the following?

1 - Headaches/history of migraines
2 - Visual aura
3 - Photophobia/phonophobia
4 - all of the above

Answer 26

4 - all of the above

Triggers include visual overload like travelling in a car, traffic lights etc..

Question 27

A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. What is the key way to differentiate this from menieres disease?

1 - lack of dizziness beyond 5 minutes
2 - female gender
3 - lack of otological symptoms
4 - history of ear infections

Answer 27

3 - lack of otological symptoms

Question 28

A vestibular migraine, or migrainous vertigo, is a type of migraine that mainly presents with dizziness symptoms lasting minutes to hours. Which of the following can be used to treat this?

1 - avoid excess caffeine
2 - avoid excess chocolate
3 - drink plenty of fluids
4 - reduce stress
5 - good sleep hygiene
6 - all of the above

Answer 28

6 - all of the above

Can also be treated in a similar manner to migraines