Vestibular Neuritis

Inflammation of the balance nerve causing days of continuous vertigo

Overview

Vestibular neuritis is inflammation of the vestibular nerve, the balance portion of the eighth cranial nerve, and is thought in most cases to be caused by reactivation of a virus such as herpes simplex. It causes sudden, severe, continuous vertigo with nausea, vomiting, and imbalance that lasts for days, followed by gradual improvement over weeks. Hearing is not affected, which distinguishes it from labyrinthitis. Examination shows a characteristic horizontal nystagmus and an abnormal head impulse test toward the affected side, findings that help separate it from stroke. Medications such as antihistamines and antiemetics are used for short term symptom relief, and corticosteroids are sometimes given, although their benefit for long term outcome is uncertain. Recovery depends largely on central compensation, the brain recalibrating to the imbalance between the two sides, which prolonged use of vestibular suppressants can slow. Most people recover well, and vestibular rehabilitation is used for persistent imbalance.