From the Research
MRI of the internal auditory canal (IAC) has limited sensitivity for diagnosing vestibular neuritis, with a sensitivity range of approximately 30-50% in the acute phase. This means that a normal MRI does not rule out vestibular neuritis 1. The diagnosis of vestibular neuritis is primarily clinical, based on a history of acute onset vertigo lasting days, horizontal-torsional nystagmus, positive head impulse test, and absence of hearing loss or neurological symptoms.
Key Points to Consider
- MRI is most useful to exclude other causes of vertigo such as stroke, multiple sclerosis, or vestibular schwannoma 2.
- When vestibular neuritis is suspected, treatment typically includes symptomatic management with vestibular suppressants like meclizine 25mg every 6-8 hours for 1-3 days, methylprednisolone 100mg daily for 3 days followed by a taper over 3 weeks, and early vestibular rehabilitation exercises to promote central compensation 3.
- The limited sensitivity of MRI for vestibular neuritis is due to the small size of the vestibular nerve and variable degree of inflammation that may not always produce visible enhancement on imaging 4.
Important Considerations for Treatment
- Vestibular rehabilitation therapy (VRT) has been shown to be effective in improving subjective and objective parameters in patients with vestibular neuritis, and can be used as a primary treatment option 3.
- Corticosteroids can be added to VRT to provide better recovery in the absence of contraindications, but the long-term efficacy of this combination is not significantly different from VRT alone 3.