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KMID : 1036520190090010001
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Clinical Neuro-Ophthalmology
2019 Volume.9 No. 1 p.1 ~ p.8
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Vestibular Neuritis versus Stroke
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Kim Ji-Soo
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Abstract
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Both vestibular neuritis (VN) and stroke may present acute prolonged spontaneous vertigo. VN is ascribed to acute unilateral loss of vestibular function, probably due to reactivation of Herpes simplex virus in the vestibular ganglia. The diagnostic hallmarks of VN are spontaneous horizontal-torsional nystagmus beating away from the lesion side, abnormal head impulse test for the involved semicircular canals, ipsilesional caloric paresis, decreased responses of vestibular-evoked myogenic potentials during stimulation of the affected ear, and unsteadiness with a falling tendency toward the lesion side. Differentiation of stroke is important due to its potential grave prognosis and different treatment modalities. The findings of bedside ocular motor examination, such as HINTS (negative head impulse tests, direction-changing nystagmus, and skew deviation) are more sensitive than brain imaging for detection of strokes in patients acute prolonged (≥ 24 hours) spontaneous vertigo. Even in patients with the typical patterns of spontaneous nystagmus observed in VN, brain imaging is indicated when the patients had unprecedented headache, positive HINTS, severe unsteadiness, or no recovery within 1-2 days.
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KEYWORD
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Vestibular neuritis, Stroke, Vertigo, Nystagmus, Head impulse test
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