vestibular neuronitis

Vestibular neuronitis :
Vestibular neuronitis may be described as acute, sustained dysfunction of the peripheral vestibular system with secondary nausea, vomiting, and vertigo.
Pathophysio :
Vestibular neuronitis appears to be a sudden disruption of afferent neuronal input from 1 of the 2 vestibular apparatuses. Causes
Viral infection of the vestibular nerve and/or labyrinth is believed to be the most common cause of vestibular neuronitis. HSV type 1 reactivation
Acute localized ischemia of these structures also may be an important cause.
Especially in children, vestibular neuritis may be preceded by symptoms of a common cold. However, the causative mechanism remains uncertain.
Clinical :
Patients usually complain of abrupt onset of severe, debilitating vertigo with associated unsteadiness, nausea, and vomiting. Vertigo increases with head movement.
Spontaneous, unidirectional, horizontal nystagmus is the most important physical finding. Nystagmus disappears on visual fixation.
Patient tends to fall toward his or her affected side when attempting ambulation or during Romberg tests.
Ix : to rule out other causes of vertigo.
Blood glucose , electrolytes and a ct brain to see any mass os ischaemic lesions.
Rx :
An intravenous (IV) line often is started to rehydrate the patient, who should be allowed to lie still in bed as desired.
H1-receptor antagonists
Dimenhydrinate 50-100 mg PO q6
Meclizine 25-50 mg PO q12-24
Prednisolone : 100 mg per day PO tapered down to 10 mg per day PO over a 3-wk period – reduce long term loss of vestibular function.