Inflammation of the vestibular nerve - usually attributed to a viral infection
It distorts the signals travelling from the vestibular system to the brain, confusing the signal required to sense movements of the head. This results in episodes of vertigo, where the brain thinks the head is moving when it is not.
Acute onset of vertigo (lasting hours or days) + may be a history of recent viral URTI
Symptoms are most severe for the first few days. Initially, vertigo may be constant, after which it is triggered or worsened by head movement. It is often associated with:
Patient presents with vertigo - Rule of central causes
Any neurological signs or symptoms should make you consider a central cause of vertigo rather than vestibular neuronitis. This may require urgent management, particularly if posterior circulation infarction (stroke) is suspected.
Head impulse test. In vestibular neuronitis the eyes will saccade as they eventually fix back on the examiner
Normal test = no current Sx or a central cause of vertigo