Vestibular neuronitis is a cause of vertigo that often develops following a viral infection.

Features

• recurrent vertigo attacks lasting hours or days
• nausea and vomiting may be present
• horizontal nystagmus is usually present
• no hearing loss or tinnitus

Differential diagnosis

• viral labyrinthitis
• posterior circulation stroke: the HiNTs exam can be used to distinguish vestibular neuronitis from posterior circulation stroke

Management

• buccal or intramuscular prochlorperazine is often used to provide rapid relief for severe cases
• a short oral course of prochlorperazine, or an antihistamine (cinnarizine, cyclizine, or promethazine) may be used to alleviate less severe cases
• vestibular rehabilitation exercises are the preferred treatment for patients who experience chronic symptoms

The HINTS exam in Vertigo

https://youtu.be/1q-VTKPweuk?si=PV7UjCfTK0ckEqAi

IMPORTANT!!! You should first screen your dizzy patients for central features that would not be expected in vestibular neuritis and may signify a central cause such as stroke. And they are:

• New Significant headache or neck pain
• Focal weakness or paresthesias
• Any dangerous D's - diplopia, dysarthria, dysmetria, dysphonia, dysphagia