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Review
. 2025 Jan 28;17(1):e78126.
doi: 10.7759/cureus.78126. eCollection 2025 Jan.

Developing a Diagnostic Algorithm for Identifying Vestibular Neuronitis in Acute Dizziness: An Overview of Epidemiology, Pathogenesis, and Evidence-Based Guidelines for Diagnostic Approaches

Petros V Vlastarakos  1 , Giorgos Sideris  1 , Eleni Vasileiou  1 , Efterpi Michailidou  2 , Nikolaos Papadimitriou  1 , Dimitrios Palantzas  1 , Konstantina Melissourgou  1 , Evangelos Panagoulis  1 , Panagiotis P Gogoulos  1 , Thomas Nikolopoulos  1
Affiliations
Review

Developing a Diagnostic Algorithm for Identifying Vestibular Neuronitis in Acute Dizziness: An Overview of Epidemiology, Pathogenesis, and Evidence-Based Guidelines for Diagnostic Approaches

Petros V Vlastarakos et al. Cureus. .

Abstract

Vestibular neuronitis (VN) is a prevalent peripheral vestibular disorder presenting with sudden unilateral vestibular loss, leading to acute vertigo without associated cochlear or neurological symptoms. Diagnosis remains challenging due to symptom overlap with other vestibular and central disorders. This study reviews the epidemiology, pathogenesis, and diagnostic approaches for VN to propose a streamlined, evidence-based diagnostic algorithm. A comprehensive literature review was conducted, analyzing 114 studies, including randomized controlled trials, systematic reviews, and clinical guidelines. Emphasis is placed on the clinical history and bedside examinations, supported by ancillary tests to confirm the diagnosis and differentiate VN from central and other peripheral causes of vertigo. The proposed algorithm aims to enhance diagnostic precision and support clinical decision-making.

Keywords: diagnostic algorithm; dizziness; head-impulse test; vertigo; vestibular neuronitis.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Algorithm for the identification of vestibular neuronitis in patients complaining of dizziness
The image has been created by the authors.
See this image and copyright information in PMC

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