Vertigo pp 67-81 | Cite as

Vestibular neuritis

  • Thomas Brandt


Acute unilateral (idiopathic) vestibular paralysis, also known as vestibular neuritis (VN), is the third most common cause of peripheral vestibular vertigo. It accounts for about 5% of the patients referred to a neurological dizziness unit. It was first described by Ruttin in 1909 and later by Nylen (1924). The term “vestibular neuronitis,” coined by Hallpike (1949) and Dix and Hallpike (1952), should be replaced by “vestibular neuritis;’ because there is strong evidence that the ganglion cells themselves are not inflamed, but rather parts of the nerve, i.e. the neurite.


Semicircular Canal Vestibular Nerve Vestibular Neuritis Horizontal Semicircular Canal Eighth Nerve 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Adour KK, Ruboyianes JM, Von Doersten PG, Byl FM, Trent CS, Quesenberry CP Jr, Hitchcock T (1990) The beneficial effect of methylprednisolone in acute vestibular vertigo. Arch Otolaryngol Head Neck Surg 116: 700–703PubMedCrossRefGoogle Scholar
  2. Arbusow V, Dieterich M, Strupp M, Dreher A, Jäger L, Brandt T (1998) Herpes zoster neuritis involving superior and anterior parts of the vestibular nerve causes ocular tilt reaction. Neuroophthalmology 19: 17–22CrossRefGoogle Scholar
  3. Ariyasu L, Byl FM, Sprague MS, Ardour KK (1990) The beneficial effect of methylprednisolone in acute vestibular vertigo. Arch Otolaryngol Head Neck Surg 116: 700–703PubMedCrossRefGoogle Scholar
  4. Aschan G, Stahle J (1956) Vestibular neuritis. J Laryngol 70: 497–511CrossRefGoogle Scholar
  5. Bagger-Sjöbäck D, Perols O, Bergenius J (1993) Audiovestibular findings in patients with vestibular neuritis: a long-term follow-up study. Acta Otolaryngol (Stockh) Suppl 503: 16–17CrossRefGoogle Scholar
  6. Baloh RW, Honrubia V, Konrad HR (1977) Ewald’s second law reevaluated. Acta Otolaryngol (Stockh) 83: 475–479CrossRefGoogle Scholar
  7. Baloh RW, Honrubia V, Yee RD, Hess K (1984) Changes in the human vestibulo-ocular reflex after loss of peripheral sensitivity. Ann Neurol 16: 222–228PubMedCrossRefGoogle Scholar
  8. Bechterew W (1883) Ergebnisse der Durchschneidung des Nervus acusticus nebst Erörterung der Bedeutung der semicirculären Kanäle für das Gleichgewicht. Pflügers Arch ges Physiol 30: 312–347CrossRefGoogle Scholar
  9. Bergenius J, Borg E (1983) Audio-vestibular findings in patients with vestibular neuritis. Acta Otolaryngol (Stockh) 96: 389–395CrossRefGoogle Scholar
  10. Bergstrom B (1973) Morphology of the vestibular nerve II. The number of myelinated vestibular nerve fibres in man at various ages. Acta Otolaryngol (Stockh) 76: 173–179CrossRefGoogle Scholar
  11. Böhmer A, Rickenmann J (1995) The subjective visual vertical as a clinical parameter of vestibular function in peripheral vestibular diseases. J Vestib Res 5: 33–45Google Scholar
  12. Böhmer A, Straumann D, Fetter M (1997) Three-dimensional analysis of spontaneous nystagmus in peripheral vestibular lesions. Ann Otol Rhinol Laryngol 106: 61–68PubMedGoogle Scholar
  13. Brandt Th, Daroff RB (1980) The multisensory physiological and pathological vertigo syndromes. Ann Neurol 7: 195–203PubMedCrossRefGoogle Scholar
  14. Brandt Th, Dieterich M (1995) Central vestibular syndromes in roll, pitch and yaw planes: Topographic diagnosis of brainstem disorders. Neuro-ophthalmology 15: 291–303Google Scholar
  15. Brandt Th, Dichgans J, Wagner W (1974) Drug effectiveness on experimental optokinetic and vestibular motion sickness. Aerospace Med 45: 1291–1297PubMedGoogle Scholar
  16. Brandt Th, Allum JHJ, Dichgans J (1978) Computer analysis of optokinetic nystagmus in patients with spontaneous nystagmus of peripheral vestibular origin. Acta Otolaryngol (Stockh) 86: 115–122CrossRefGoogle Scholar
  17. Brandt Th, Krafczyk S, Malsbenden I (1981) Postural imbalance with head extension: improvement by training as a model for ataxia therapy. Ann NY Acad Sci 374: 646–649CrossRefGoogle Scholar
  18. Brandt Th, Dieterich M, Büchele W (1986) Postural abnormalities in central vestibular brainstem lesions. In: Bles W, Brandt Th (eds) Disorders of posture and gait. Elsevier, Amsterdam, pp 142–156Google Scholar
  19. Büchele W, Brandt Th (1988) Vestibular neuritis, a horizontal semicircular canal paresis? Adv Oto-Rhino-Laryngol 42: 157–161Google Scholar
  20. Cawthorne T (1944) The physiologic basis for head exercises. J Chart Soc Physiother 106–107Google Scholar
  21. Courjou JH, Jeannerod M, Ossuzio I, Schmidt R (1977) The role of vision on compensation of vestibulo-ocular reflex after hemilabyrinthectomy in the cat. Exp Brain Res 28: 235–248Google Scholar
  22. Darlington Cl, Smith PF (1992) Pre-treatment with a Ca2+ channel antagonist facilitates vestibular compensation. NeuroReport 3: 143–145CrossRefGoogle Scholar
  23. Davis LE (1993) Viruses and vestibular neuritis: review of human and animal studies. Acta Otolaryngol (Stockh) Suppl 503: 700–773Google Scholar
  24. Davis LE, Johnson RT (1976) Experimental viral infections of the inner ear. I. acute infections of the newborn hamster labyrinth. Lab Invest 34: 349–356Google Scholar
  25. Depondt M (1973) La neuronite vestibulaire, paralysie vestibulaire à caractères particulier. Acta Oto-Rhino-Laryngol Belg 27: 323–359Google Scholar
  26. Dieterich M, Büchele W (1989) MRI findings in lesions at the entry zone of the eighth nerve. Acta Otolaryngol (Stockh) Suppl 468: 385–389CrossRefGoogle Scholar
  27. Dix MR, Hallpike CS (1952) The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Ann Otol (St Louis) 61: 987Google Scholar
  28. Ewald R (1892) Physiologische Untersuchungen über das Endorgan des Nervus octavus. Bergmann, WiesbadenGoogle Scholar
  29. Fetter M, Dichgans J (1996) Vestibular neuritis spares the inferior division of the vestibular nerve. Brain 119: 755–763PubMedCrossRefGoogle Scholar
  30. Foster CA (1994) Vestibular rehabilitation. Baillières Clin Neurol 3: 577–592PubMedGoogle Scholar
  31. Francis DA, Bronstein AM, Rudge P, du Boulay EPGH (1992) The site of brainstem lesions causing semicircular canal paresis: an MRI study. J Neurol Neurosurg Psychiatry 55: 446–449PubMedCrossRefGoogle Scholar
  32. Furuta Y, Takasu T, Fukuda S, Inuyama Y, Sato KC, Nagashima K (1993) Latent herpes simplex virus type 1 in human vestibular ganglia. Acta Otolaryngol (Stockh) Suppl 503: 85–89CrossRefGoogle Scholar
  33. Gilchrist DP, Smith PF, Darlington CL (1990) ACTH (4–10) accelerates ocular motor recovery in the guinea pig following vestibular deafferentation. Neurosci Lett 118: 14–16PubMedCrossRefGoogle Scholar
  34. Goldberg JM, Fernandez C (1971) Physiology of peripheral neurons innervating semicircular canals of the squirrel monkey: 1. Resting discharge and response to constant angular accelerations. J Neurophysiol 34: 635–660Google Scholar
  35. Hain TC, Fetter M, Zee DS (1987) Head-shaking nystagmus in patients with unilateral peripheral vestibular lesions. Am J Otolaryngol 8: 36–47PubMedCrossRefGoogle Scholar
  36. Hallpike CS (1949) The pathology and differential diagnosis of aural vertigo. Proc 4th Intern Congress Otolaryngol, London, Br Med Ass 2: 514Google Scholar
  37. Hallpike CS (1961) On the case for repeal of Ewald’s second law: Some introductory remarks. Acta Otolaryngol (Stockh) Suppl 149: 7–14CrossRefGoogle Scholar
  38. Halmagyi GM, Curthoys IS (1988) A clinical sign of canal paresis. Arch Neurol 45: 737–739PubMedCrossRefGoogle Scholar
  39. Halmagyi GM, Curthoys IS, Cremer PD, Henderson CJ, Todd MJ, Staples MJ, D’Cruz DM (1990) The human horizontal vestibuloocular reflex in response to high-acceleration stimulation before and after unilateral vestibular neurectomy. Exp Brain Res 81: 479–490PubMedCrossRefGoogle Scholar
  40. Hamid M, Roberts VJ, Haddon K (1991) Monocular and binocular suppression of vestibular nystagmus. Acta Otolaryngol (Stockh) Suppl 481: 424–427CrossRefGoogle Scholar
  41. Hasuike K, Sekitani T, Imate Y (1995) Enhanced MRI in patients with vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 519: 272–274CrossRefGoogle Scholar
  42. Herdman SJ (1994) Vestibular rehabilitation. FA Davis, PhiladelphiaGoogle Scholar
  43. Hilding DA, Kanda T, House WF (1968) Vestibular neuronitis and small acoustic neuroma: electron microscopic observations. Otol Clin N Am 305–318Google Scholar
  44. Hirata Y, Sekitani T, Okinaka Y, Matsuda Y (1989) Serovirological study of vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 468: 371–373CrossRefGoogle Scholar
  45. Hirata Y, Gyo K, Yanagihara N (1995) Herpetic vestibular neuritis: an experimental study. Acta Otolaryngol (Stockh) Suppl 519: 93–96CrossRefGoogle Scholar
  46. Hopf HC (1987) Vertigo and masseter paresis. A new local brain-stem syndrome probably of vascular origin. J Neurol 235: 42–45PubMedCrossRefGoogle Scholar
  47. Hunt JR (1908) A further contribution to the herpetic inflammation of the geniculate ganglion. Am J Med Sci 136: 226–241CrossRefGoogle Scholar
  48. Hydén D, Ödkvist LM, Kylén P (1979) Vestibular symptoms in mumps deafness. Acta Otolaryngol (Stockh) Suppl 360: 182–183Google Scholar
  49. Igarashi M, Levy JK, 0-Uchi T, Reschke MF (1981) Further study of physical exercise and locomotor balance compensation after unilateral labyrinthectomy in squirrel monkey. Acta Otolaryngol (Stockh) 92: 101–105CrossRefGoogle Scholar
  50. Imate Y, Sekitani T, Okami M, Miura M (1995) Central disorders in vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 519: 204–205CrossRefGoogle Scholar
  51. Ishikawa K, Togawa K (1988) Effect of blindfolding one eye on vestibular compensation in guinea pigs. Acta Otolaryngol (Stockh) Suppl 198; 47: 55–60CrossRefGoogle Scholar
  52. Ishikawa K, Edo M, Togawa K (1993) Clinical observations of 32 cases of vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 13–15CrossRefGoogle Scholar
  53. Ishiyama A, Ishiyama GP, Lopez I, Eversole LR, Honrubia V, Baloh RW (1997) Histopathology of idiopathic chronic recurrent vertigo. Laryngoscope 106: 1340–1346CrossRefGoogle Scholar
  54. Ishizaki H, Pyykkö I, Nozue M (1993) Neuroborreliosis in the aetiology of vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 67–69CrossRefGoogle Scholar
  55. Jerram AH, Darlington CL, Smith PF (1995) Methylprednisolone reduces spontaneous nystagmus following unilateral labyrinthectomy in guinea pig. Eur J Pharmacol 275: 291–293PubMedCrossRefGoogle Scholar
  56. Jung R (1953) Nystagmographie. Zur Physiologie und Pathologie des optisch-vestibulären Systems beim Menschen. In: von Bergmann G, Frey W, Schwieck H (eds) Handbuch der Inneren Medizin, 4th Ed. Springer, Berlin, Vol 5 /1, pp 1325–1379Google Scholar
  57. Jung R, Mittermaier K (1939) Zur objektiven Registrierung und Analyse verschiedener Nystagmusformen: Vestibulärer, optokinetischer und spontaner Nystagmus in ihren Wechselbeziehungen. Arch Ohr Nas Kehlkopfheilk 146: 410–439Google Scholar
  58. Kamei T (1975) Der biphasisch auftretende Kopfschüttelnystagmus Arch Otolaryngol 209: 59–67Google Scholar
  59. Katsarkas A, Galiana HL (1984) Bechterew’s phenomenon in humans. A new explanation. Acta Otolaryngol (Stockh) Suppl 406: 95–100Google Scholar
  60. Kömpf, D (1986) Der benigne pseudovestibuläre Kleinhirninsult. Nervenarzt 57: 163–166PubMedGoogle Scholar
  61. Kornhuber H, Waldecker G (1958) Akute isolierte periphere Vestibularisstörungen. Arch Ohr usw Heilk Z Hals usw Heilk 173: 340–346CrossRefGoogle Scholar
  62. Lacour M (1984) Réapprentissage et période postopératoire sensible dans la restauration des fonctions nerveuses. Exemple de la compensation vestibulaire et implications cliniques. Ann OtoLaryng 101: 177–187Google Scholar
  63. Lindsay JR, Hemenway WG (1956) Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otolaryngol 65: 692–706Google Scholar
  64. Longridge NS (1989) Recurrent vestibulopathy: Support for a viral aetiology. J Otolaryngol 18: 99–100PubMedGoogle Scholar
  65. Lorente De No R (1933) Vestibulo-ocular reflex arc. Arch Neurol Psychiat 30: 245–291CrossRefGoogle Scholar
  66. Magnusson M, Norrving B (1993) Cerebellar infarctions and “vestibular neuronitis”. Acta Otolaryngol (Stockh) Suppl 503: 64–66CrossRefGoogle Scholar
  67. Matsou T (1986) Vestibular neuronitis: serum and CSF virus antibody titre. Auris Nasus Larynx 13: 111–134Google Scholar
  68. Matsuo T, Sekitani T, Honjo S, Imate Y, Inokuma T (1989) Vestibular neuronitis. Pathogenesis in the view of virological study of CSF. Acta Otolaryngol (Stockh) Suppl 468: 365–369Google Scholar
  69. Matsuzaki M, Kamei T (1995) Stage assessment of the progress of continuous vertigo of peripheral origin by means of spontaneous and head-shaking nystagmus findings. Acta Otolaryngol (Stockh) Suppl 519: 188–190CrossRefGoogle Scholar
  70. Meran A, Pfaltz CR (1975) Der akute Vestibularisausfall. Arch OtoR hin o-L aryngol 209: 229–244CrossRefGoogle Scholar
  71. Murofushi T, Halmagyi GM, Yavor RA, Colebatch JG (1996) Absent vestibular evoked myogenic potentials in vestibular neurolabyrinthitis: An indicator of inferior vestibular nerve involvement? Arch Otolaryngol Head Neck Surg 122: 845–848PubMedCrossRefGoogle Scholar
  72. Nadol JB (1995) Vestibular neuritis. Otolaryngol Head Neck Surg 112: 162–172PubMedCrossRefGoogle Scholar
  73. Nahmias AJ, Roizman BC (1973) Infection with herpes-simplex viruses 1 and 2. N Engl J Med 289: 719–725PubMedCrossRefGoogle Scholar
  74. Nylen CO (1924) Some cases of ocular nystagmus due to certain positions of the head. Acta Otolaryngol (Stockh) 6: 106–137CrossRefGoogle Scholar
  75. Ogata Y, Sekitani T, Shimogori H, Ikeda T (1993) Bilateral vestibu- lar neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 57–60CrossRefGoogle Scholar
  76. Ohbayashi S, Oda M, Yamamoto M, Urano M, Harada K, Horikoshi H, Orihara H, Kitsuda C (1993) Recovery of the vestibular function after vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 31–34CrossRefGoogle Scholar
  77. Ohm J (1932) Über die Beziehungen zwischen willkürlichen, optischen und vestibulären Augenbewegungen. Z Hals Nas Ohrenheilk 32: 234–246Google Scholar
  78. Okinaka Y, Sekitani T, Okazaki H, Miura M, Tahara T (1993) Progress of caloric response of vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 18–22CrossRefGoogle Scholar
  79. Proctor L, Perlman H, Lindsay J, Matz G (1979) Acute vestibular paralysis in herpes zoster oticus. Ann Otol Rhinol Laryngol 88: 303–310PubMedGoogle Scholar
  80. Ruttin B (1909) Zur Differentialdiagnose der Labyrinth-and Hörnerverkrankungen. Z Ohrenheilk 57: 327–331Google Scholar
  81. Safran AB, Vibert D, Issoua D, Häusler R (1994) Skew deviation after vestibular neuritis. Am J Ophthalmol 118: 238–245PubMedGoogle Scholar
  82. Sando I, Black FO, Hemenway WG (1972) Spatial distribution of vestibular nerve in internal auditory canal. Ann Otol 81: 305Google Scholar
  83. Schuknecht HF (1985) Neurolabyrinthitis. Viral infections of the peripheral auditory and vestibular systems. In: Nomura Y (ed) Hearing loss and dizziness, Igaku-Shoin, Tokyo, New York, pp 1–15Google Scholar
  84. Schuknecht HF, Donovan ED (1986) The pathology of idiopathic sudden sensorineural hearing loss. Arch Oto Rhino Laryngol 243: 1–15CrossRefGoogle Scholar
  85. Schuknecht HF, Kitamura K (1981) Vestibular neuritis. Ann Otol Rhinol Laryngol 90, Suppl 78: 1–19Google Scholar
  86. Schuknecht HF, Witt RL (1985) Acute bilateral sequential vestibular neuritis. Am J Otolaryngol 6: 255–257PubMedCrossRefGoogle Scholar
  87. Schulz P, Arbusow V, Strupp M, Dieterich M, Rauch E, Brandt T (1998) Highly variable distribution of HSV-1-specific DNA in human geniculate, vestibular and spiral ganglia. Neurosci Lett 252: 139–142PubMedCrossRefGoogle Scholar
  88. Sekitani T, Imate Y, Noguchi T, Inokuma T (1993) Vestibular neuronitis: epidemological survey by questionnaire in Japan. Acta Otolaryngol (Stockh) Suppl 503: 9–12CrossRefGoogle Scholar
  89. Shimizu T, Sekitani T, Hirata T, Hara H (1993) Serum viral antibody titre in vestibular neuronitis. Acta Otolaryngol (Stockh) Suppl 503: 74–78CrossRefGoogle Scholar
  90. Shirabe S (1988) Vestibular neuronitis in childhood. Acta Otolaryngol (Stockh) Suppl 458: 120–122CrossRefGoogle Scholar
  91. Silvoniemi P (1988) Vestibular neuronitis. An otoneurological evaluation. Acta Otolaryngol (Stockh) Suppl 453: 1–72CrossRefGoogle Scholar
  92. Sloane PD Baloh RW, Honrubia V (1989) The vestibular system in the elderly: clinical implications. Am J Otolaryngol 10: 442–449Google Scholar
  93. Smith PF, Darlington CL (1994) Can vestibular compensation be enhanced by drug treatment? J Vestib Res 4: 169–179PubMedGoogle Scholar
  94. Strupp M, Arbusow V, Dieterich M, Sautier W, Brandt T (1998a) Perceptual and oculomotor effects of neck muscle vibration in vestibular neuritis: Ipsilateral somatosensory substitution of vestibular function. Brain 121: 677–685Google Scholar
  95. Strupp M, Arbusow V, Maag KP, Gall C, Brandt T (1998b) Vestibular exercises improve central vestibulospinal compensation after vestibular neuritis. Neurology 51: 838–844PubMedCrossRefGoogle Scholar
  96. Strupp M, Jäger L, Müller-Lisse U, Arbusow V, Reiser M, Brandt T (1998c) High resolution Gd-DTPA MR imaging of the inner ear in 60 patients with idiopathic vestibular neuritis: no evidence for contrast enhancement of the labyrinth or vestibular nerve. J Vestib Res 8: 1–7CrossRefGoogle Scholar
  97. Suzuki J, Cohen B (1964) Head, eye, body and limb movements from semicircular canal nerves. Exp Neurol 10: 333–405CrossRefGoogle Scholar
  98. Tahara T, Sekitani T, Imate Y, Kanesada K, Okami M (1993) Vestibular neuronitis in children. Acta Otolaryngol (Stockh) Suppl 503: 49–52CrossRefGoogle Scholar
  99. Tran Ba Huy P (1994) Physiopathology of peripheral nonMeniere’s vestibular disorders. Acta Otolaryngol (Stockh) Suppl 513: 5–10CrossRefGoogle Scholar
  100. Vibert D, Häusler R, Safran AB, Koerner F (1996) Diplopia from skew deviation in unilateral peripheral vestibular lesions. Acta Otolaryngol (Stockh) 116: 170–176CrossRefGoogle Scholar
  101. Wennmo C, Pyykkö I (1982) Vestibular neuronitis. A clinical and electro-oculographic analysis. Acta Otolaryngol (Stockh) 94: 507–515Google Scholar
  102. Yamanaka T, Sasa M, Amano T, Miyahara H, Matsunaga T (1995) Role of glucocorticoid in vestibular compensation in relation to activation of vestibular nucleus neurons. Acta Otolaryngol (Stockh) Suppl 519: 168–172CrossRefGoogle Scholar
  103. Zajtchuk J Matz G, Lindsay J (1972) Temporal bone pathology in herpes oticus. Am Otol Rhinol Laryngol 81: 331–338Google Scholar
  104. Zee DS (1985) Perspectives on the pharmacotherapy of vertigo. Arch Otolaryngol 3: 609–612Google Scholar
  105. Zee DS, Preiosi TJ, Proctor LR (1982) Bechterew’s phenomenon in a human patient. Ann Neurol 12: 495PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2003

Authors and Affiliations

  • Thomas Brandt
    • 1
  1. 1.Neurologische Klinik, Klinikum GroßhadernLudwig-Maximillians-UniversitätMunichGermany

Personalised recommendations