Vestibular neuritis is diagnosed clinically, from a single prolonged episode of severe vertigo lasting days, with nausea and unsteadiness but without hearing loss or other neurological features. The critical task is distinguishing it from a stroke. A cerebellar or brainstem stroke can present with isolated vertigo, so specific examination of eye movements is what separates the two.
Vestibular neuritis is diagnosed clinically, from a single prolonged episode of severe vertigo lasting days, with nausea and unsteadiness but without hearing loss or other neurological features. The critical task is distinguishing it from a stroke. A cerebellar or brainstem stroke can present with isolated vertigo, so specific examination of eye movements is what separates the two.
Sudden onset of severe continuous vertigo, usually developing over hours, accompanied by nausea, vomiting and marked unsteadiness. It is a single episode rather than a recurrent pattern, and the worst of it lasts days before gradually improving over weeks. Hearing is not affected, which distinguishes it from labyrinthitis where hearing loss accompanies the vertigo. Head movement makes it dramatically worse, so people lie very still.
This is the part that matters most, because a stroke in the cerebellum or brainstem can present with isolated vertigo and looks similar from the outside. Specific bedside examination of eye movements is what distinguishes them, assessing the pattern of nystagmus, whether the eyes realign correctly when the head is turned, and whether there is vertical misalignment. Features that point towards a central cause include the inability to walk unaided, nystagmus that changes direction with gaze, new deafness, double vision, or any weakness or speech disturbance.
Imaging is arranged where central features are present, where vascular risk factors are significant, or where the examination is not reassuring, and it is performed externally. Ordinary CT is poor at detecting posterior circulation stroke, so MRI is generally the appropriate study. Recovery relies on central compensation and is helped considerably by vestibular rehabilitation; prolonged use of vestibular suppressant medication delays it, which is why those drugs are used briefly rather than continuously.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: dizziness and vertigo; National Institute of Neurological Disorders and Stroke; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.