Vestibular paroxysmia caused by contralateral tortuous vertebral artery: A case report.

Abstract

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.

• Authors: Jin Woo Choi, Chang-Hee Kim
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 45 Pg. e27815 (Nov 12 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 34766594 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Topics

• Hemifacial Spasm
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Nerve Compression Syndromes
• Nystagmus, Pathologic
• Tinnitus (etiology)
• Vertebral Artery (diagnostic imaging)
• Vertigo (etiology)
• Vestibulocochlear Nerve