1/7. Evaluation of acute vertigo: unusual lesions imitating vestibular neuritis.The acute onset of vertigo is a common clinical problem presenting to primary care physicians or otologists for evaluation. Usually the underlying disease process is benign and self-limited in nature. In the absence of hearing loss or additional neurologic findings, a common initial diagnosis is vestibular neuritis. The patient is treated symptomatically and observed for spontaneous resolution. However, other more serious disease processes may mimic the presentation of vestibular neuritis and be misdiagnosed. Five cases of serious central nervous system disorders that were similar to vestibular neuritis in their initial presentation are reviewed to illustrate this point. Each patient presented with the acute onset of continuous vertigo without associated hearing loss. The correct diagnosis was established only after further evaluation was pursued. Recommendations for the initial and subsequent evaluation of these patients are discussed.- - - - - - - - - - ranking = 1keywords = neuritis (Clic here for more details about this article) |
2/7. Acute bilateral sequential vestibular neuritis.Two cases of bilateral sequential vestibular neuritis demonstrate the significant persistent disequilibrium that follows involvement of the second ear. The etiology for the loss of vestibular function is postulated to be a viral neuritis. Vestibular suppressant drugs are helpful in relieving nausea and vomiting in the acute phase of the disease; however, they are of no therapeutic value for the protracted disequilibrium following involvement of the second ear. An awareness of this disorder as a disease entity will minimize diagnostic and therapeutic frustration on the part of the physician and provide a realistic prognosis for the patient. Unfortunately, the prognosis is for permanent but somewhat lessening disequilibrium with the passage of time and depends in great part on the subject's age.- - - - - - - - - - ranking = 0.85714285714286keywords = neuritis (Clic here for more details about this article) |
3/7. Acute cranial polyneuritis with vertigo after stapedectomy.Acute vertigo occurring 48 hours after stapedectomy is assumed to be related to inner ear trauma. Similarly, acute vertigo occurring weeks after stapedectomy could be related to a fistula of the oval window. No one has tested the hypothesis that some of these cases could represent concomitant cranial polyneuritis. We report the development after stapedectomy of five cases of acute cranial polyneuritis with vertigo diagnosed by physical examination of the cranial nerves. In another case we determined that vertigo occurring after stapedectomy was not related to concomitant cranial polyneuritis. Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.- - - - - - - - - - ranking = 1.1428571428571keywords = neuritis (Clic here for more details about this article) |
4/7. Second Louis H. Clerf Lecture. Vestibular neuritis.Vestibular neuritis is a discrete degenerative neuropathy of the vestibular nerve trunks. The clinical manifestations consist of one or more severe prolonged episodes of vertigo, sometimes in association with milder periodic or constant unsteadiness. The atrophic changes in the vestibular nerves are usually sufficiently severe to create vestibular test abnormalities. The clinical and pathological features are consistent with a viral etiology.- - - - - - - - - - ranking = 0.71428571428571keywords = neuritis (Clic here for more details about this article) |
5/7. Histopathology of idiopathic chronic recurrent vertigo.Vestibular neuritis is a degenerative neuropathy of the peripheral vestibular system. The etiology of this condition is uncertain, although it is generally believed to be viral. A small percentage of patients with vestibular neuritis have chronic recurrent episodes of vertigo. Detailed cytologic descriptions of acute or chronic vestibular neuritis are lacking, and no previous studies have reported evidence of chronic inflammation in human temporal bone specimens. The authors of this study examined temporal bone specimens from three patients with a history of chronic recurrent vertigo of unknown cause. Varying degrees of inflammation and destruction were seen in the vestibular system, and mild involvement of the cochlear system was noted. These findings are consistent with postinfectious inflammatory changes of the cochlear-vestibular system analogous to a postinfectious syndrome involving the central nervous system.- - - - - - - - - - ranking = 0.42857142857143keywords = neuritis (Clic here for more details about this article) |
6/7. Unilateral vestibular neuritis with otolithic signs and off-vertical axis rotation.Off-vertical axis rotation (OVAR) at constant velocity is a dynamic otolith stimulus that induces horizontal and vertical eye movement responses. To determine the value of this examination as a test for unilateral otolithic hypofunction, we compared the OVAR responses of patients suffering from acute vestibular neuritis (VN) without any sign of otolith affection, with those of patients suffering from acute VN with otolithic signs. The horizontal eye movement bias component shows directional preponderance (DP) significantly higher in patients with otolithic signs than in patients not presenting them. However, as bias DP also reflects the imbalance between right and left horizontal canals activity, this greater bias DP could be explained by the more severe canals impairment-evaluated by caloric test-found in patients with otolithic signs. No significant difference can be shown on horizontal modulation. The DP of vertical modulation is significantly higher in patients presenting otolithic signs than in patients not presenting them: in the case of otolithic signs, the responses are smaller during rotations toward the affected side. Therefore, this variable could be used as an indication of unilateral otolithic hypofunction.- - - - - - - - - - ranking = 0.71428571428571keywords = neuritis (Clic here for more details about this article) |
7/7. Idiopathic bilateral vestibular loss.We describe the clinical and laboratory features of 13 patients with bilateral loss of peripheral vestibular sensitivity of no known cause. In the office, screening for this condition was possible using illegible e-testing and examination of the patient for refixation saccades after brisk head movements while attempting visual fixation. diagnosis was confirmed by bilaterally reduced caloric responses (< 20 degrees/second on all 4 caloric irrigations) and abnormally low gain of the vestibulo-ocular reflex on rotational chair testing. The mean age of the patients was 68 years. We noted two patterns of symptom onset: onset associated with vertigo (10 patients) and insidious progressive disequilibrium not associated with vertigo (3 patients). Only 38% of the patients complained of subjective oscillopsia. The subjects performed poorly on platform posturography, particularly when deprived of visual and somatosensory feedback. When associated with vertigo, bilateral vestibular loss may be the result of bilateral sequential vestibular neuritis; when not associated with vertigo, disequilibrium may be caused by slow, symmetrical loss of peripheral function as a result of aging. Although the subjects in this report were elderly, idiopathic bilateral vestibular loss has been reported in patients of all ages.- - - - - - - - - - ranking = 0.14285714285714keywords = neuritis (Clic here for more details about this article) |