Short vertigo attacks in childhood: vestibular paroxysmia

Aims: Description of clinical presentation, diagnosis and therapy of vestibular paroxysmia

Methods: Case-report on 2 patients

Results: Case 1: 9 year old boy, who suffers from short rotatory and to-and-fro vertigo attacks several times a day which started 4 years ago. Attacks are provoked by intense or prolonged movements; some attacks occur spontaneously. During attacks, he also complains about unsteadiness of gait and postural imbalance, blurred vision and oscillopsia. The neurologic examination between attacks is normal; the caloric vestibular testing shows a reduced response on the left side. The brain MRI shows asymmetry of the A. cerebelli inferior anterior (AICA) with a nerv-artery contact of the left vestibulo-cochlear nerve at the root-entry zone to the brainstem. Under oral therapy with carbamazepine 100mg/d no more attacks occurred. Attacks reoccurred as soon as the drug was withdrawn, therefore therapy was started again and attacks diappeared.

Case 2: 8 year old boy, who suffers similar attacks occurring several times a day which started 6 month ago. With attacks he also developed intense headache, sometimes oscillopsia, hypacusis and/or double vision. The neurologic examination between attacks is normal. Caloric vestibular testing shows a deficit on the left side; the audiogram shows a discrete left sided deficit for low frequencies (5–10db). Brain MRI shows an unusual anatomy of the left AICA which travels between N. acusticus and N. vestibularis. Therapy with carbamazepine (50mg/d) was started and led to a reduction of the attacks (1–2/week).

Conclusion: Vestibular paroxysmia is an important differential diagnosis in children with short vertigo attacks. In our outpatient clinic we make this diagnosis in about 2% of the consulting children. A complete patient history is most helpful. The pathological nerve-artery contact can be depicted on MRI (CISS Sequence). More important is the response to the treatment with carbamazepine. A treatment trial is justified if patients suffer from frequent attacks.

vestibular paroxysmia - vertigo - children