Can a 16-year-old girl develop vestibular neuritis?

Can Vestibular Neuritis Occur in a 16-Year-Old Girl?

Yes, vestibular neuritis can absolutely occur in a 16-year-old girl, though it is less common in adolescents than in adults.

Age Distribution and Epidemiology

Vestibular neuritis can occur at any age, including adolescence 1. While it has an annual incidence of 3.5 per 100,000 population in the general population and accounts for approximately 7% of patients at specialized vertigo clinics 2, pediatric cases are documented in the literature 3. In a pediatric vestibular clinic series, patients ranged from 5-19 years old (mean 13.1 years), with equal gender distribution 3.

Clinical Presentation in Adolescents

The clinical features in adolescents mirror those in adults:

• Sudden onset of severe rotational vertigo lasting more than 24 hours, typically persisting for several days 4, 5, 2
• Profound nausea and vomiting with marked imbalance 4, 6
• Horizontal-torsional spontaneous nystagmus beating away from the affected ear 4, 2
• No cochlear symptoms (hearing loss, tinnitus, or aural fullness) and no other neurological deficits 5
• Falling tendency toward the lesion side 4, 2

In the pediatric series, all patients presented with sudden rotational vertigo, imbalance, and nausea lasting an average of 10 days without other associated symptoms 3.

Diagnostic Confirmation

The diagnosis relies on characteristic vestibular testing abnormalities:

• Abnormal head impulse test toward the affected ear (positive in 5 of 8 pediatric patients tested) 3
• Ipsilateral caloric paresis (abnormal in 2 of 2 pediatric patients tested) 3
• Abnormal rotary chair testing (8 of 9 pediatric patients) 3
• Deviation of subjective visual vertical toward the affected ear 2

Critical Differential Diagnosis Considerations

In any adolescent presenting with acute vestibular syndrome, you must exclude central causes before diagnosing vestibular neuritis 1, 7. Red flags requiring urgent MRI brain without contrast include 8:

• Focal neurological deficits (dysarthria, limb weakness, diplopia)
• Severe postural instability with inability to stand or walk
• Downbeating or direction-changing nystagmus
• Normal head impulse test (suggests central pathology)
• Skew deviation on alternate cover testing
• New severe headache accompanying vertigo
• Significant vascular risk factors (less common in adolescents but consider arterial dissection)

Common pitfall: Assuming a normal neurologic examination excludes stroke—75-80% of posterior circulation strokes presenting with acute vestibular syndrome lack focal deficits 8.

Age-Specific Recovery Patterns

Adolescents may have different recovery trajectories than younger children:

• Incomplete recovery is more common in older adolescents (≥15 years) compared to younger children—36% overall in the pediatric series, with all incomplete recoveries occurring in patients ≥15 years old 3
• Early vestibular rehabilitation (initiated ≤14 days from onset) was associated with complete recovery in 3 of 4 pediatric patients, while delayed rehabilitation (≥90 days) was associated with incomplete recovery 3

Treatment Approach

Acute Phase (First 3-5 Days)

• Vestibular suppressants and antiemetics for severe symptoms, but discontinue as soon as tolerable 7, 6
• Avoid prolonged use of vestibular suppressants (meclizine, benzodiazepines) as they impede central compensation and delay recovery 7, 6
• Oral corticosteroids may accelerate recovery if initiated within 3 days of onset—neither of the two pediatric patients who received steroids had incomplete recovery, though this requires further validation 3, 6

Subacute and Chronic Phase

• Early vestibular rehabilitation should be initiated as soon as the acute phase resolves, ideally within 14 days 3, 6
• Encourage early mobilization and resumption of normal activity to promote central compensation 6, 2

Follow-Up

• Reassess within 1 month to document resolution or persistence of symptoms 7
• If symptoms persist beyond 1-2 days or worsen, obtain brain imaging to exclude central pathology 4

When to Reconsider the Diagnosis

Brain imaging is indicated even with typical vestibular neuritis features if 4:

• Unprecedented severe headache
• Negative (normal) head impulse test
• Severe unsteadiness or inability to walk
• No recovery within 1-2 days
• Any additional neurological signs 7