Neurology · MU Sofia

88. Vertigo, vestibular neuronitis, Ménière disease

Covers vertigo as a symptom of vestibular dysfunction, separating peripheral causes such as vestibular neuritis and Ménière disease and benign positional vertigo from central causes like stroke, multiple sclerosis and tumours. A table contrasts nystagmus, severity, neurological signs and hearing loss between peripheral and central vertigo. It then describes vestibular neuronitis, including its viral origin, clinical features, examination findings, treatment and prognosis, followed by Ménière disease with its pathophysiology, classic triad, attacks, diagnosis, long-term and refractory treatment.

Inside: 1 section · 1 table · 16 flashcards · 2 min

Topic 88 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 273 words (2 min of reading), with 16 flashcards.

In this note

  1. Vertigo. Vestibular neuronitis.Ménière disease

Vertigo. Vestibular neuronitis.Ménière disease

1. Vertigo

Definition: Vertigo is the illusion of movement (usually spinning) due to dysfunction of the vestibular system (inner ear or central pathways).

Types

A. Peripheral Vertigo

  • Lesion in inner ear or vestibular nerve: Vestibular neuritis. Ménière disease. Benign paroxysmal positional vertigo (BPPV)

B. Central Vertigo

  • Brainstem or cerebellar lesions: Stroke. Multiple sclerosis. Tumors

Key Clinical Difference

2. Vestibular Neuronitis

Definition: Vestibular neuronitis is an acute inflammatory disorder of the vestibular nerve causing sudden severe vertigo without hearing loss.

Etiology: Viral infection (post-viral inflammation)

Clinical Features

  • Acute Phase: Sudden severe vertigo. Nausea and vomiting. Gait instability
  • Key Feature: No hearing loss (important distinction from labyrinthitis)

Examination: Spontaneous horizontal nystagmus. Positive head impulse test. Normal hearing

Diagnosis

  • Clinical diagnosis: Exclusion of central causes (MRI if needed)

Treatment

Acute

  • Vestibular suppressants: Antihistamines (meclizine). Benzodiazepines

Recovery Phase: Vestibular rehabilitation exercises

Prognosis: Usually self-limiting over days to weeks

3. Ménière Disease

Definition: Ménière Disease is a chronic disorder of the inner ear characterized by episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness, due to endolymphatic hydrops.

Pathophysiology

  • Excess endolymph in inner ear
  • Increased pressure in membranous labyrinth
  • Distortion of vestibular + cochlear function

Clinical Features

  • Classic Triad: Recurrent vertigo attacks. Fluctuating sensorineural hearing loss. Tinnitus
  • Additional Features: Aural fullness (ear pressure). Nausea and vomiting during attacks.
  • Vertigo Attacks: Sudden onset. Last 20 minutes to several hours. Recurrent episodes

Examination: Nystagmus during attacks. Hearing loss (low-frequency initially)

Diagnosis

  • Clinical criteria: Audiometry (sensorineural hearing loss). Exclusion of central causes

Treatment

  • Acute Attack: Vestibular suppressants. Antiemetics
  • Long-Term Management: Low-salt diet. Diuretics. Betahistine
  • Refractory Cases: Intratympanic gentamicin. Surgery (endolymphatic sac decompression)

Prognosis: Chronic relapsing course. Progressive hearing loss over time

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