Vestibular Neuronitis Flashcards
What is vestibular neuronitis?
It is defined as an inner ear condition in which there is inflammation of the vestibulocochlear nerve
What is the pathophysiological cause of vestibular neuronitis?
Viral Infection
What are the two classifications of vestibular neuronitis?
Acute Vestibular Neuronitis
Chronic Vestibular Neuronitis
What is acute vestibular neuronitis?
It is defined as the initial phase which occurs for one week
The clinical features are sudden and severe
What is chronic vestibular neuronitis?
It is defined as the secondary phase which occurs for weeks to months
The clinical features are milder
What are the five clincial features associate with vestibular neuronitis?
Nausea & Vomiting
Sudden, Severe Vertigo
Intense Dizziness
Severe Ataxia
Horizontal Nystagmus
How long does vertigo last for in vestibular neuronitis?
Hours to Days
What investigation is used to diagnose vestibular neuronitis?
HINTS Examination
What is the HINTS examination?
It is an examination involving the head impulse test, nystagmus and test of skew
How is the head impulse test conducted?
It involves asking individuals to keep their eyes fixed on a target, and the examiner moving the patient’s head quickly and unpredictably to 10 – 15 degrees of neck rotation
What is normal head impulse test result?
The head movement should stimulate the vestibulo ocular reflex, in which the patient’s eye remain on the target following movement
What is a positive head impulse test result?
The head movement results in the patient’s eyes moving off the target, followed by a corrective saccade back to the target
How is the test of skew conducted?
It involves asking individuals to look at the examiners nose
The examinaer covers one of their eyes
The examiner then quickly moves their hand to cover the patient’s other eye - observing the uncovered eye for any vertical and/or diagnal corrective movement
What is a normal test of skew result?
There is no vertical and/or diagnoal corrective movement
What is a positive test of skew result?
There is vertical and/or diagonal corrective movement
What three HINTS examination results indicate vestibular neuronitis?
Abnormal Head Impulse Test
Unidirectional Horizontal Nystagmus
No Vertical Skew
What are the two pharmacological management options of acute vestibular neuronitis?
Anti-Emetics
Antihistamines
What is the first line management option of acute vestibular neuronitis?
Anti-Emetics
Name an anti-emetic used to manage acute vestibular neuronitis
Prochlorperazine
What administeration route of prochlorperazine is recommended in mild acute vestibular neuronitis?
Oral
What course duration of oral prochlorperazine is recommended to manage acute vestibular neuronitis? Why?
Short course
This is due to the fact that long term treatment will delay recovery by interfering with central compensatory mechanisms
What two administeration routes of prochlorperazine are recommended in severe acute vestibular neuronitis?
Buccal
Intramuscular
What is the second line management option of acute vestibular neuronitis?
Antihistamines
Name three antihistamines are used to manage acute vestibular neuronitis
Cinnarizine
Cyclizine
Promethazine
