Abstract
A 54-year-old man complained of paroxysmal vertigo when his head turned to the right or left.Counter-clockwise rotatory nystagmus, accompanied by a turning sensation, was provoked transiently when the headhung low and was turned to the right or left. However, the results of other neuro-otological tests were almost normal.Digital subtraction angiography revealed reversal of the aortic arch and kinking of the left vertebral artery. “Cervicovestibular syndrome” was suspected, and perivascular sympathectomy of the left vertebral artery was performed.After the removal of a tight adhesion between the left vertebral artery and the anterior scalenus muscle, paroxysmal positional vertigo disappeared and nystagmus was greatly improved. The operative results suggest that the origin of the paroxysmal positional vertigo was constrictive ischemia of the left vertebral artery caused by a mechanical compression of the scalenus anterior muscle when the head was turned and irritation of the perivascular sympathetic nerve-plexus.
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