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Etiologically, a viral inflammation is assumed. In most cases, an isolated dysfunction of the superior part of the vestibular nerve can be found (superior part UVP\u2009=\u2009sUVP), but an additional involvement of the inferior part has also been shown (whole nerve UVP\u2009=\u2009s+iUVP). The aim of the study was (a) to determine the prevalence of an additional inferior part involvement, (b) to quantify the extent of vestibular deficit comparing sUVP vs. s+iUVP and (c) to examine the long-term outcome focusing on psychological distress as well as long-lasting symptoms associated with dizziness.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>96 UVP patients were enrolled. They underwent a neuro-otological examination including measurements of cervical vestibular evoked myogenic potentials (cVEMP), subjective visual vertical (SVV), ocular torsion (OT), caloric testing and the clinical head impulse test (HIT) in the acute phase. The Symptom Checklist-90 R and the Vertigo Symptom Scale were examined at a mean follow-up interval of 4.0\u00a0years (\u00b1\u20090.4\u00a0years) after disease onset.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among the 96 patients (47 female; mean age 58\u2009\u00b1\u200914\u00a0years), additional involvement of the inferior nerve part was found in 35 cases (36%). These patients showed a significantly greater tilt of SVV (6.3\u00b0\u2009\u00b1\u20094.4\u00b0 vs. 4.2\u00b0\u2009\u00b1\u20093.7\u00b0; F\u2009=\u20095.581, p\u2009=\u20090.020) and a more pronounced OT (15.1\u00b0\u2009\u00b1\u20098.2\u00b0 vs. 11.3\u00b0\u2009\u00b1\u20097.4\u00b0; F\u2009=\u20094.770, p\u2009=\u20090.032) in the acute stage of the disease. The proportion of pathological HIT was significantly higher in the s+iUVP group (82.9% vs. 67.2%; Chi-Square\u2009=\u200920.167, p\u2009&lt;\u20090.001). cVEMPs showed significantly decreased amplitude on the affected side (124.8\u00a0\u00b5V (\u00b1\u200910.3\u00a0\u00b5V) vs. 408.4\u00a0\u00b5V (\u00b1\u200926.6\u00a0\u00b5V); F\u2009=\u200961.911; p\u2009&lt;\u20090.001). At long-term follow-up, the patients with s+iUVP had significantly increased anxiety scores as compared to patients with isolated sUVP (SCL-90 score for anxiety: 48.4\u2009\u00b1\u20093.8 vs. 41.6\u2009\u00b1\u20090.5; F\u2009=\u20094.231, p\u2009=\u20090.026).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Discussion<\/jats:title>\n            <jats:p>An additional lesion of the inferior part of the vestibular nerve led to increased vestibular dysfunction in acute UVP and might trigger long-lasting symptom persistence. Identifying these patients early might improve the clinical outcome, lead to a faster improvement and prevent secondary psychosomatic symptoms.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00415-025-13160-7","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T19:04:50Z","timestamp":1748286290000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute peripheral unilateral vestibulopathy of the whole nerve causes increased impairment of spatial orientation and poorer long-term outcome"],"prefix":"10.1007","volume":"272","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7195-4272","authenticated-orcid":false,"given":"Christoph","family":"Best","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidrun H.","family":"Kr\u00e4mer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Dieterich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"13160_CR1","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/s10072-014-1912-4","volume":"36","author":"I Adamec","year":"2015","unstructured":"Adamec I, Krbot Skoric M, Handzic J, Habek M (2015) Incidence, seasonality and comorbidity in vestibular neuritis. 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H.H.K.: received travel grants from Alexion and Grifols, lecturing honoraria and consulting fees from Sanofi, Alexion, Roche Pharma, Argenx, UCB and Amgen and research support from Roche and Argenx\u00a0- all unrelated to this publication. M.D.: was supported by the Deutsche Stiftung Neurologie (DSN, German Foundation of Neurology, project 80721017) and by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany\u2019s Excellence Strategy (Munich Cluster for Systems Neurology: EXC 2145 SyNergy).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the local ethical committee and performed in accordance with the standards of the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standard"}}],"article-number":"422"}}