May 06, 2020
The First Attack of Vertigo – Is it a Stroke or is it Inner Ear Disease?
Vestibular Paroxysmia is a rare condition with significant overlap in symptoms and signs with other causes of dizziness, so is difficult to diagnose with certainty.
It is thought to be due to an overlying compression, by the anterior inferior cerebellar artery, lateral to the midpoint of the acoustic nerve (8th cranial nerve). This compression irritates this nerve and is the inner ear equivalent of trigeminal (5th cranial nerve) or glossopharyngeal (9th cranial nerve) neuralgia.
The symptoms are of a progressing, very frequent short-lived vertigo or imbalance lasting seconds, usually less than 1 minute, which often is triggered by head movements. It can be associated with buzzing, hearing loss and feeling of pressure around the affected ear.
Physical signs are of horizontal jerk or rotary nystagmus beating to the affected side.
Diagnosis is made more certain if: –
i) the patient is able to record, using a phone “selfie” video technique, the nystagmus.
ii) the condition is unresponsive to vestibular sedation medication.
iii) responds to carbamazepine/oxcarbazepine.
iv) an overlying compression, by the anterior inferior cerebellar artery, on MRI.
It can be seen there is significant overlap between the various possible presentation of other causes of dizziness such as BPPV, central positional vertigo, Meniere’s disease, vestibular migraine and vestibular neuronistis.