Diagnosis and Treatment of Vestibular Neuritis/Neuronitis or Peripheral Vestibulopathy (PVP)? Open Questions and Possible Answers

Abstract

: The acute vestibular syndrome is a clinically defined entity consisting of vertigo or dizziness that develops acutely over minutes to hours and is accompanied by nausea/vomiting, gait instability, head motion intolerance, and nystagmus, while persisting over a day or more. When it is caused by a peripheral vestibular lesion and is not associated with clinically manifest auditory deficits, it is mostly labeled vestibular neuritis/neuronitis/neuropathy or sometimes peripheral vestibulopathy. Here, we propose hypotheses and discuss current research advances on viral or vascular factors in the pathogenesis, the recurrence, the site of lesion, old and new treatment options, contraindicated measures, the differential diagnosis, and the prognosis of vestibular neuritis/neuronitis/neuropathy or vestibulopathy. Possibly, other structures than the vestibular nerve are also involved in the pathogenetic process and the label peripheral vestibulopathy would be more apt.

Morphological and functional correlates of vestibular synaptic deafferentation and repair in a mouse model of acute-onset vertigo

“…With the evolution of methods for vestibular functional evaluation, questions have been increasingly raised regarding the precise anatomical locations of the lesions that cause AUV symptoms. Recently, the hypothesis of an intralabyrinthine origin has been proposed (Hegemann and Wenzel, 2017).…”

Spontaneous Recovery of the Vestibulo-Ocular Reflex After Vestibular Neuritis; Long-Term Monitoring With the Video Head Impulse Test in a Single Patient

“…If impairment is confined to regions innervated by the inferior vestibular nerve (posterior SCC and saccule) this is called inferior vestibular neuritis ( 10 ). Some use the term vestibular neuronitis , ( 11 )—implying that the lesion involves vestibular ganglion cells. If the patient also develops Benign Positional Vertigo (BPV) the term neurolabyrinthis ( 12 ) is used.…”

Reduced Balance Restoration Capacities Following Unilateral Vestibular Insult in Elderly Mice

“…Intracochlear damages may also be involved in a majority of sensory neural hearing loss ( 24 ). Several authors believe that an intralabyrinthine process is massively underestimated or ignored in the peripheral vestibulopathy (PVP) ( 43 , 44 ). It can therefore be assumed that selective damage to the vestibular primary synapses could support all of the symptoms experienced in PVP.…”