A Complex Presentation of Vestibular Paroxysmia in an Adolescent with Wolf Parkinson White Syndrome

Abstract

Vestibular paroxysmia is an episodic vestibular disorder resulting from compression or irritation of the eighth cranial nerve. It is a rare and difficult diagnosis in children. We report the case of a 16-year-old adolescent male with a history of syncope, COVID-19 infection four months prior who presented with intermittent episodes of vertigo and unsteadiness several times a week. These events started abruptly, and he appeared frozen. However, he remained conscious and was able to answer questions. He subsequently resumed normal activity in less than a minute without seizure stigmata or post ictal period. His general and neurological examinations were unremarkable. Extensive diagnostic workup yielded negative results, except for an EKG consistent with Wolf-Parkinson-White syndrome. However, his symptoms persisted after cardiac ablation, suggesting they were not related to this arrhythmia. Following unsuccessful trials with various medications, his symptoms resolved with carbamazepine. Early recognition and appropriate treatment of this condition could substantially improve the quality of life for affected individuals.