Vestibular neuronitis (vestibular neuritis)
Definition
Vestibular neuronitis is an acute peripheral vestibular disorder characterised by sudden, isolated, spontaneous and sustained rotational vertigo caused by dysfunction of the vestibular nerve. It is a common cause of the acute vestibular syndrome seen in the emergency department and must be distinguished promptly from central causes (particularly posterior circulation stroke) (NICE NG127).
Aetiology and pathophysiology
- Most cases are presumed post‑infectious inflammation of the vestibular nerve, often following a viral upper respiratory tract infection.
- The inflammatory process is confined to the vestibular nerve; cochlear function is preserved.
- If hearing is affected, consider labyrinthitis or another cochlear process rather than vestibular neuronitis.
- There is no single diagnostic test - diagnosis is clinical, supported by focused bedside vestibular assessment and exclusion of central causes.
Typical presentation
- Onset and course: sudden onset of continuous rotational vertigo developing over minutes-hours (acute vestibular syndrome).
- Symptom severity is usually greatest in the first 48-72 hours and improves over days-weeks; most people show substantial recovery by 6 weeks.
- Symptoms: severe vertigo worse with head movement or position change, marked nausea and often vomiting, and unsteadiness with a tendency to fall toward the affected side.
- Associated features absent in uncomplicated vestibular neuronitis: hearing loss, persistent tinnitus, and focal neurological signs.