Vestibular Paroxysmia: (Disabling Positional Vertigo)

Abstract

Evidence is presented for neurovascular cross-compression of the eighth nerve as the probable cause for vestibular paroxysmia (also termed disabling positional vertigo), a condition that can be treated effectively by carbamazepine. In analogy to trigeminal neuralgia, the diagnosis is based on five characteristic features: (1) short attacks of rotational or to-and-fro vertigo lasting from seconds to minutes, (2) attacks frequently dependent on particular head positions and whose duration is modified by changing head position, (3) hypacusis or tinnitus permanently or during the attack, (4) measurable auditory or vestibular deficits by neurophysiological methods, and (5) efficacy of carbamazepine. However, a pathognomonic sign is still lacking and current imaging techniques for identification of causative nerve-vessel contacts still have to be improved.