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Vestibular Paroxysmia

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About the Disease

Vestibular Paroxysmia results from the compression of the vestibular nerve, often due to microvascular compression. This condition is characterized by brief, recurrent episodes of vertigo, which can be triggered by various factors, including blood vessels, vestibular neuritis, tumors such as acoustic neuroma, radiation treatments, and surgeries on the VIII nerve. Microvascular compression is one of the most common causes of this condition.

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Symptoms

  1.  Vertigo: Brief spells of dizziness or vertigo lasting from seconds to minutes.
  2.  Frequency: These spells may occur several times per day.
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Diagnosis

To evaluate Vestibular Paroxysmia and its severity, the following tests are recommended:

  •  MRI Brain: Preferably 3D MRI with FT-FISS or CISS, which is positive in 95% of cases.
  •  Videonystagmography / Electronystagmography: Positive in 66% of cases.
  •  EEG: Conducted to rule out seizures.
  •  Audiometry: Positive in 50% of cases.
  •  Fasting Blood Glucose: To rule out fluctuating blood sugar levels.
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Treatment

The primary treatment for Vestibular Paroxysmia involves addressing neurovascular compression of the cochleovestibular nerve:

  •  Medications: Treatment with carbamazepine or oxcarbazepine is usually effective and can also serve as a diagnostic tool. Vestibular suppressants are not effective for this condition.
  •  Surgical Intervention: If medical treatment is insufficient, surgery may be necessary. Microvascular decompression of a vascular loop compressing the vestibular nerve can be performed endoscopically with minimal morbidity by experienced surgeons.

Effective management of Vestibular Paroxysmia can significantly improve patients’ quality of life by reducing the frequency and severity of vertigo episodes.

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