Early video head impulse testing in the emergency department and each day of admission is feasible and well tolerated. There is marked variation in VOR gain in patients with symptoms and signs of VN, and low initial VOR gains are a predictor for low VOR gains on subsequent days. Improvement in VOR gains was seen in most patients.

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ObjectivesTransient vertigo preceding the main attack of vestibular neuritis has been reported from Korea, exclusively as a single episode in the previous week. Such attacks have parallels with TIA, raising the possibility of a vascular mechanism for vestibular neuritis. We aimed to compare vestibular neuritis patients with and without transient premonitory vertigo to determine whether there was an age difference or VOR gain reduction difference between the two groups.MethodsConsecutive patients with acute vestibular syndrome with onset in the previous 48 hours, were enrolled. Following a detailed history and examination, ICS Impulse video oculography (GN Otometrics) was performed daily during the admission.ResultsAmong 30 patients with acute vestibular syndrome, there were three who had transient vertigo preceding the main attack. Two had a single episode, one lasting 30 min and the other a few hours, both four days prior to presentation. Another had two episodes of a few minutes duration in the preceding 30 days with two more brief attacks on the day of presentation. All three were men, mean age 49.3 years (range 43–68), versus 62.4 years (range 33–88) in the remainder (NS). None had vascular risk factors. The mean VOR gain on the affected side was 0.52 versus 0.65 in the remaining 27 patients (NS).ConclusionsTransient premonitory vertigo may precede an attack of presumed vestibular neuritis by several days or more. More than one attack can occur. Our numbers are small and the results not statistically significant, but these patients are younger and have significant VOR gain reductions unlike some much older patients with subtle acute vestibulopathy and small VOR gain reductions. More patients are needed for firmer conclusions, but transient premonitory vertigo may have the opposite significance to TIA, and supports a viral rather than a vascular mechanism for the acute vestibular syndrome.