From the Guidelines
Viral vertigo, also known as vestibular neuritis, is a condition characterized by sudden onset of vertigo, nausea, and vomiting, typically lasting several days to weeks.
Diagnosis
The diagnosis of vestibular neuritis is primarily based on clinical presentation and history, with key features including sudden onset of vertigo, nausea, and vomiting 1.
Treatment
Treatment often involves antivertigo medications such as meclizine (25-50mg every 4-6 hours) or dimenhydrinate (50-100mg every 4-6 hours) for symptom management, and corticosteroids like prednisone (60mg daily for 3 days, then tapered over 7-10 days) to reduce inflammation 1.
- Vestibular rehabilitation therapy may be recommended to promote central compensation and improve balance function 1.
- The use of vestibular suppressant medications such as antihistamines and/or benzodiazepines is not routinely recommended for BPPV treatment 1. Some key points to consider in the management of vestibular neuritis include:
- Patient education on the condition, its impact on daily life, and the importance of follow-up 1.
- Counseling on the risk of falls and the need for home safety assessments, particularly in the elderly or those with preexisting balance disorders 1.
- Monitoring for recurrence and potential underlying or concurrent vestibular or CNS disorders 1.
From the FDA Drug Label
Meclizine hydrochloride tablets are indicated for the treatment of vertigo associated with diseases affecting the vestibular system in adults The diagnosis of vestibular neuritis (Viral Vertigo) is not directly addressed in the drug label. The treatment of vestibular neuritis (Viral Vertigo) with meclizine is not explicitly stated as the drug label only mentions the treatment of vertigo associated with diseases affecting the vestibular system in adults, without specifying vestibular neuritis. Key points:
- The drug label does not provide a clear diagnosis for vestibular neuritis.
- Meclizine may be used to treat vertigo associated with diseases affecting the vestibular system, but its use for vestibular neuritis is not directly stated. 2
From the Research
Diagnosis of Vestibular Neuritis
- Vestibular neuritis is an acute peripheral vestibulopathy characterized by prolonged continuous vertigo, nausea, vomiting, and imbalance 3
- The diagnosis is based on the patient's clinical history and physical examination, and it is essential to rule out central causes such as brainstem or cerebellar stroke or hemorrhage 3
- The characteristic signs and symptoms include sudden and prolonged vertigo, absence of auditory symptoms, and absence of other neurological symptoms 4
Treatment of Vestibular Neuritis
- Most patients recover well from vestibular neuritis, even without treatment 3
- A course of oral steroids may accelerate the recovery of vestibular function, but its influence on long-term outcome is less certain 3
- Antiemetics and vestibular suppressants are useful acutely but should be withdrawn as soon as possible to promote central vestibular compensation 3
- Early resumption of normal activity and directed vestibular rehabilitation therapy can further promote the recovery process 3, 5
- Vestibular rehabilitation improves balance control, promotes visual stabilization with head movements, and expands static and dynamic posture stability 5
Causes and Pathogenesis
- The aetiology and pathogenesis of vestibular neuritis remain unknown, but proposed theories include viral infections, vascular occlusion, and immunomediated mechanisms 4
- Vestibular neuritis has been reported as a rare complication after the adenoviral vector-based COVID-19 vaccine 6
- Histopathological studies have demonstrated degeneration of the superior vestibular nerve in patients with vestibular neuritis 4