Vestibular Neuronitis

Question 1

When does it typically develop?

Answer 1

After a viral infection

Question 2

What features are associated with it?

Answer 2

Recurrent vertigo attacks lasting hours or days
Nausea and vomiting
Horizontal nystagmus
No hearing loss or tinnitus

Question 3

What differentials are there?

Answer 3

Viral labyrinthitis

Posterior circulation stroke

Question 4

How is it managed?

Answer 4

Vestibular rehabilitation exercises are preferred for those with chronic symptoms
Buccal or IM prochlorperazine- rapid relief in severe cases
Short course of oral prochlorperazine or an antihistamine to alleviate less severe cases

Question 5

What exam can be used to diagnose vestibular neuritis and rule out stroke?

Answer 5

HINTS

Question 6

What are the 3 components of the HINTS?

Answer 6

Nystagmus - observe in primary gaze and lateral gaze (take away fixation)
Test of (vertical) skew - cover eye with hand, does eye move when you remove hand? (If it does = worrisome)
Head impulse test (abnormal if vestibular neuritis)

Question 7

What is the head impulse test?

Answer 7

Looking for a nerve problem - abnormal = good as unlikely a brain problem
Hold onto their skull, patient fixes on your nose, move head back and forward slowly to relax muscles then move head briskly to centre - look for catch up saccade

Question 8

What is a reassuring HINTS exam?

Answer 8

All of:
Unidirectional nystagmus
No vertical skew
Abnormal head impulse test

Question 9

What is a worrisome HINTS exam?

Answer 9

Any of:
Bidirectional nystagmus
Abnormal test of skew
Normal head impulse test