Vestibular Neuritis: A Detailed Case Study

Vestibular neuritis is a disorder characterized by the sudden onset of vertigo, nausea, and imbalance due to inflammation of the vestibular nerve. This article presents a second illustrative case, focusing on diagnostic challenges and management strategies.

Case Presentation

Examination and Key Findings

On physical examination, the patient had spontaneous horizontal nystagmus with a torsional component, beating away from the affected ear. The head impulse test was positive on the right side. Romberg test showed a tendency to fall to the right. There was no focal neurological deficit. Dix-Hallpike maneuver was negative. Audiometry was normal bilaterally.

Diagnosis

Based on the history of acute vertigo, positive head impulse test, and absence of auditory symptoms, a diagnosis of vestibular neuritis was made. MRI brain with contrast was performed to rule out central causes, such as stroke or demyelinating disease, and was normal.

Keywords for Vestibular Neuritis

• vertigo
• vestibular neuritis
• nystagmus
• head impulse test
• imbalance
• nausea
• vestibular rehabilitation
• corticosteroids

Management and Outcome

The patient was started on oral corticosteroids (prednisone 60 mg daily for 7 days with a taper) and vestibular suppressants (meclizine as needed) for the first 48 hours. She was also referred for vestibular rehabilitation therapy. At two-week follow-up, her vertigo had significantly improved, though she still reported mild imbalance when walking in the dark. She continued with home exercises and was advised to avoid driving until symptoms resolved completely.

This case emphasizes the classic presentation of vestibular neuritis and the importance of early diagnosis and appropriate management. Key keywords such as vertigo, vestibular neuritis, and vestibular rehabilitation are essential for clinical recognition and treatment planning.