2022 Volume 115 Issue 1 Pages 15-22
Vestibular paroxysmia (VP) is a clinical syndrome characterized by recurrent spontaneous vertigo, probably caused by neurovascular compression of the eighth cranial nerve. The diagnostic criteria for VP have been proposed by Strupp et al., and the criteria do not include detection of neurovascular compression of the nerve on MRI. We report three cases of refractory repetitive vertigo that were successfully treated with carbamazepine. They had recurrent vertigo accompanied by tinnitus or headache. Treatment for common vertigo or vestibular migraine proved ineffective. The duration of the vertigo attacks ranged from a few seconds to 30 seconds, and the frequency of vertigo attacks was high, ranging from tens to hundreds of attacks per day, suggesting the possibility of VP. No abnormalities were detected on brain MRI, including the internal auditory meatus or cerebellopontine angle, in either case. All three patients were treated with carbamazepine, which resulted in marked improvement of their vertigo attacks, and were diagnosed as having VP.
We suggest that for patients with repetitive vertigo who do not respond to common treatments for vertigo, diagnostic treatment with antiepileptic medications, such as carbamazepine, should be attempted, taking into account the possibility of VP, even in the absence of abnormalities on MRI.
