4.5 Article

Vestibular paroxysmia caused by contralateral tortuous vertebral artery A case report

期刊

MEDICINE
卷 100, 期 45, 页码 -

出版社

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MD.0000000000027815

关键词

hemifacial spasm; nystagmus; tinnitus; vertebrobasilar dolichoectasia; vestibular paroxysmia

资金

  1. National Research Foundation of Korea (NRF) - Korea government (MSIP) [2021R1F1A1062019]
  2. National Research Foundation of Korea [2021R1F1A1062019] Funding Source: Korea Institute of Science & Technology Information (KISTI), National Science & Technology Information Service (NTIS)

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Vestibular paroxysmia (VP) is characterized by spontaneous, recurrent, short, paroxysmal attacks of vertigo with or without tinnitus, and can be caused by neurovascular cross-compression. Treatment with medications such as oxcarbazepine can lead to significant symptom relief in patients with VP.
Rationale: Vestibular paroxysmia (VP) is characterized by spontaneous, recurrent, short, paroxysmal attacks of vertigo with or without tinnitus. Patient concerns: We report a case of paroxysmal recurrent vertigo accompanying clicking tinnitus on the left side in a 61-year-old patient. He had undergone microvascular decompression to treat the left-side hemifacial spasm 6 years prior. The patient first developed vertigo attacks about 3 years after microvascular decompression, and the attacks increased in frequency over the last 4 months. Video-nystagmography revealed a background right-beating nystagmus which was reversed every 55 seconds, to left-beating nystagmus for 17 seconds. Diagnosis: Brain magnetic resonance imaging and angiography demonstrated a compression of the cisternal segment of the left vestibulocochlear nerve between the tortuous right vertebral artery and the posterior wall of the left porus acusticus internus. Interventions and outcomes: Under the diagnosis of VP, 300 mg oxcarbazepine was administered daily, which relieved the symptoms dramatically. Lesson: The neurovascular cross-compression of the vestibulocochlear nerve by the contralateral vertebral artery tortuosity can cause VP. Periodic paroxysms of right-beating nystagmus accompanying the left-side tinnitus during vertigo attacks in our patient can be explained by secondary central hyperactivity in both vestibular and cochlear nuclei following long-standing neurovascular cross-compression.

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