Vestibular neuronitis

1. Big picture

Vestibular neuronitis, more commonly called vestibular neuritis, is one of the classic causes of acute continuous peripheral vertigo. In the exam, it is important because it can look dramatic — severe rotatory vertigo, vomiting, nystagmus, inability to walk normally — but it is usually a peripheral vestibular lesion, not a stroke.

The examiner mainly wants you to know:

1. It causes acute severe rotatory vertigo lasting days.

2. It has harmonic peripheral vestibular signs.

3. There is no hearing loss, tinnitus, or aural fullness.

4. The dangerous mimic is posterior circulation stroke, especially cerebellar or brainstem stroke.

5. Treatment is mainly short-term symptomatic treatment + early mobilization/vestibular rehabilitation, with methylprednisolone early if started within the first few days.