Acute Labyrinthitis (Vestibular Neuritis)

Presumed viral
  • Abrupt onset vertigo
  • Occurs w/ or w/o head movement
  • Duration >60 secs.
  • Severe for 24-48 hrs.
  • Mild Sx may persist a few wks
  • Subtle non-specific imbalance may last months
Main Chore:  R/O Stroke
  • See Table below
  • During active vertigo & nystagmus, 3 Bedside Maneuvers are very sensitive & specific
Follow-Up
  • After complete recovery, consider inquiring about past episodes of unrelated neurologic Sx possibly compatible with Multiple Sclerosis

See posting Vertigo – 1.

SUGGESTION OF STROKE AS CAUSE OF VERTIGO

Stroke Risk Factors
  • Age >60
  • Hypertension
  • Diabetes
  • Connective tissue disorder
Stroke Symptoms (vertebro-basilar)
  • diplopia
  • dysarthria
  • dysphagia
Suggestion of Vertebral Artery Dissection
  • Severe head or neck pain
  • Recent trauma
Signs of Vertebro-Basilar Stroke on Exam
  • EOM deficit
  • Rotary or vertical nystagmus
  • Horner’s (unilateral ptosis, miosis, absent sweating)
  • Deficits in CN 9-12 (including hoarseness)
  • Unilateral deficit in coordination (finger-to-nose or heel-down-shin tests)
  • Loss of pinprick sensation involving one side of face & opposite side of trunk
  • Abnormal Romberg with eyes open (in vestibular disease, position maintained with feet together eyes open, but not eyes closed)
  • If vertigo & nystagmus actively present, a normal horizontal Head Thrust (hHT) (or “head impulse test”)  implies stroke [click for description]