Acute unilateral vestibulopathy (“vestibular neuritis”)

The leading symptom of acute unilateral vestibulopathy, previously called vestibular neuritis, is an acute onset of spinning vertigo, an apparent movement of the visual surrounding (“oscillopsia”) and a tendency to fall to the affected side. It is most often caused by the reactivation of a latent Herpes simplex 1 infection. This leads to a swelling and damage of the vestibular nerve. The condition is most frequently observed in patients between 30 and 60 years of age

Signs and Symptoms

Acute onset of spinning vertigo and oscillopsia are the hallmarks of acute unilateral vestibulopathy. In addition, the patients have postural imbalance, a tendency to fall to the affected side and suffer from nausea and vomiting.

Diagnosis

Acute unilateral vestibulopathy is diagnosed on the basis of exclusion. The key signs are a horizontal-rotatory peripheral vestibular spontaneous nystagmus to the non-affected side, which can generally be suppressed by visual fixation. Therefore, Frenzel’s goggles or the new M glasses are essential for the diagnosis. The head-impulse test is pathological on the affected side.

Findings arguing against acute unilateral vestibulopathy include skew deviation, a central fixation nystagmus, a gaze-evoked nystagmus in the opposite direction of the spontaneous nystagmus, saccadic smooth pursuit and a normal head-impulse test (“the big five”).

Observable ocular motor disorders

  • Horizontal-rotatory peripheral vestibular spontaneous nystagmusn

References

Strupp M, Magnusson M (2015). Acute Unilateral Vestibulopathy. Neurol Clin 33:669-685. PubMed