Journal List > J Korean Med Assoc > v.51(11) > 1042093

Choi and Goh: Vestibular Neuritis and Bilateral Vestibulopathy

Abstract

Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. The key signs and symptoms are the acute onset of sustained rotatory vertigo without hearing loss, postural imbalance with Romberg's sign, and peripheral type nystagmus. Head thrust and caloric tests show ipsilateral hyporesponsiveness, but hearing test shows normal. Either an inflammation of the vestibular nerve or labyrinthine ischemia was proposed as a cause of vestibular neuritis. Recovery after vestibular neuritis is usually incomplete. Despite the assumed viral cause, the effects of corticosteroids, antiviral agents, or the two in combination are uncertain. Bilateral vestibulopathy is a rare disorder of the peripheral labyrinth or the eighth nerve. The most frequent etiologies include ototoxicity, autoimmune disorders, meningitis, neuropathies, sequential vestibular neuritis, cerebellar degeneration, tumors, and miscellaneous otological diseases. The two key symptoms are unsteadiness of gait and oscillopsia associated with head movements or when walking. The diagnosis is made with the simple bedside tests for defective vestibulo-ocular reflex (head thrust and dynamic visual acuity tests). Bilateral vestibulopathy is confirmed by the absence of nystagmus reaction to both caloric and rotatory chair tests. The spontaneous recovery is relatively rare and incomplete. Vestibular rehabilitation is supportive of the improvement, but the efficacy of physical therapy is limited.

Figures and Tables

Figure 1
Spontaneous nystagmus in a patient with right vestibular neuritis. The fast phases of mixed torsional-horizontal nystagmus directs toward the intact ear. The nystagmus increases with gaze in the direction of nystagmus, and decreases with gaze in the opposite direction. Visual fixation markedly suppress the nystagmus.
*Recording of horizontal eye movement of the left eye
Recording of vertical eye movement of the left
Recording of torsional eye movement of the left eye
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Figure 2
Bithermal caloric tests show a complete canal paresis in the left ear in a patient with left vestibular neuritis.
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Figure 3
Rotatory chair test shows increased phase lead and the asymmetry with normal gain of the vestibulo-ocular reflex in a patient with left vestibular neuritis.
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Figure 4
Ocular torsion to the left side in a patient with left vestibular neuritis.
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Figure 5
Normal vestibular- evoked myogenic potentials in a patient with right vestibular neuritis.
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Figure 6
Posturographic data in a patient with vestibular neuritis. The scores of condition 4, 5, 6 are decreased.
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Figure 7
Bithermal caloric tests show markedly decreased respones to warm and cold stimulation bilaterally in a patient with bilateral vestibulopathy.
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Figure 8
Rotatory chair test shows increased phase lead and decreased gain of the vestibulo-ocular reflex in a patient with bilateral vestibulopathy.
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Table 1
Commonly used antivertiginous and antiemetic drugs
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Table 2
Causes of bilateral vestibulopathy
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