Case Reports Vestibular Neuritis Caused by Enteroviral Infection Yakup Ergul, MD, Barıs Ekici, MD, Yucel Tastan, MD, Taner Sezer, MD, and Serap Uysal, MD Vestibular neuritis is characterized by the sudden onset of nausea, vomiting, and spontaneous horizontal or horizonto-rotatory nystagmus. The etiology of the disease is multifactorial. Mumps, rubella, herpes sim- plex virus type 1, cytomegalovirus, and Epstein-Barr virus may have a role in the disease. Enteroviruses are among the other rare causes. This report presents a 7-year-old male admitted with nausea, vomiting, rota- tory vertigo, horizonto-rotatory nystagmus with posi- tive Romberg’s sign and positive head-thrust test. Cranial magnetic resonance imaging and audiometry of the patient were normal. He was diagnosed with vestibular neuritis, and steroid therapy was initiated. At the second month of follow-up, all symptoms had regressed. To the best of our knowledge, this case report describes the first pediatric patient in whom enteroviral ribonucleic acid is documented both in cerebrospinal fluid and in nasopharyngeal material in active disease. This finding supports the possible role of enteroviruses in the etiology of vestibular neuritis. © 2006 by Elsevier Inc. All rights reserved. Ergul Y, Ekici B, Tastan Y, Sezer T, Uysal S. Vestibular neuritis caused by enteroviral infection. Pediatr Neurol 2006;34:45-46. Introductıon Vestibular neuritis is the second most common cause of peripheral vestibular vertigo; its incidence in the popula- tion is 3.5 in 100,000 [1]. The most distinctive clinical features of the disease are sudden onset of rotatory vertigo, spontaneous horizontal or horizonto-rotatory nystagmus, nausea, and vomiting [1-4]. This disease is also termed neuronitis because both the labyrinth and vestibular nerve can be affected [2,3]. The etiology of the disease is multifactorial. Preceding respiratory infection may have a role in the etiology of pediatric cases [4]. Only in 7% of vertigo cases, viral pathogens were demonstrated, espe- cially mumps, rubella, herpes simplex virus type 1, cyto- megalovirus, and Epstein-Barr virus [3,5-7]. Enteroviruses are among the other rare viral causes [5]. The best approach would be to treat the underlying disease; how- ever, the pathophysiology is uncertain, there is no estab- lished treatment, and symptomatic therapy is typically used [1]. The main groups of drugs used for symptoms of acute vertigo include antihistamines, anticholinergic agents, an- tidopaminergic agents, steroids, and antivirals such as valacyclovir [1,2]. The present case is notable because enteroviral infections are a rare cause of vertigo and the patient manifested a rapid response to steroid therapy. No complication due to steroid therapy was observed. Case Report The patient, a 7-year-old male, was admitted to a clinic with headache, vomiting, and dizziness which began 10 days earlier. He was diagnosed with acute respiratory infection and received 3 days of oral antibio- therapy. In the follow-up, nystagmus and balance problems appeared. After cerebrospinal fluid sampling, intravenous ceftriaxone and acyclovir treatment were initiated and the patient was referred to our clinic for possible central nervous system infection. In the initial examination, he was conscious, blood pressure was within normal limits (100/60 mm Hg), and growth percentiles were normal. He had dizziness, horizontal and sometimes rotatory nystagmus which was aggravated by head move- ments. He was not able to sit or stand up. Romberg’s sign and head-thrust test were positive. There were no visual problems, meningeal signs, clonus, or pathologic reflexes. The other physical examination findings were normal. Complete blood count revealed the following: white blood cells 8900/mm 3 , hemoglobin 11.3 gm/dL, hematocrit 39%, and platelets 356,000/mm 3 . Biochemical values were normal. On cerebrospinal fluid examination, pressure and appearance were normal, there were 40 white blood cells/mm 3 . Cerebrospinal fluid glucose concentration was 66 mg/dL and protein concentration was 22 gm/dL. Hemoculture remained sterile. Cranial magnetic resonance imaging and audiography were normal. Vestibular neuritis was considered in the diagnosis of the patient, From Department of Pediatrics, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey. Communications should be addressed to: Dr. Ergul; I ˙ stanbul U ¨ niversitesi; Cerrahpas ¸a Tıp Fakültesi; Çocuk Sag ˇlıg ˇı ve Hastalıkları Anabilim Dalı; I ˙ stanbul, Turkey. E-mail: yakupergu177@hotmail.com Received January 6, 2005; accepted May 12, 2005. 45 © 2006 by Elsevier Inc. All rights reserved. Ergul et al: Vestibular Neuritis and Enteroviral Infection doi:10.1016/j.pediatrneurol.2005.05.025 ● 0887-8994/06/$—see front matter