Vestibular Paroxysmia

Vestibular Paroxysmia is when individuals experience short, recurrent episodes of vertigo (a spinning sensation). This condition is caused by compression of the vestibular nerve, which is responsible for maintaining balance. 

What causes Vestibular Paroxysmia?

The most common cause is a blood vessel pressing against the vestibular nerve, typically a branch of the anterior inferior cerebellar artery (AICA). The pulsating blood vessel interferes with the nerve’s function, leading to symptoms. Less common causes include:

• Fibrosis (scar tissue) after radiation therapy or surgery
• Inflammation of the vestibular nerve (vestibular neuritis)
• Tumors such as vestibular schwannoma

Symptoms

Vestibular paroxysms can be suspected when a person experiences:

• Brief episodes of vertigo lasting seconds to minutes 
• Instability: feeling off-balance
• Triggers: Symptoms may worsen with changes in head position or hyperventilation
• Hearing issues: Temporary hearing loss or rear ringing(tinnitus) during episodes, which usually resolves afterwards. 

How Is Vestibular Paroxysmia Diagnosed?

Doctors may perform the following tests:

1. Audiometry: To check for fluctuating hearing loss or normal hearing.
2. Videonystagmography (VNG): This test identifies involuntary eye movements (nystagmus) triggered by hyperventilation, head shaking, or positional changes. The pattern of nystagmus differs from that seen in conditions like Benign Paroxysmal Positional Vertigo (BPPV).
3. Electroencephalogram (EEG): To rule out seizures, which can mimic the symptoms of vestibular paroxysmia.
4. MRI with gadolinium contrast: Special imaging techniques, such as 3D Constructive Interference in Steady State (CISS), can confirm the presence of microvascular compression of the vestibular nerve.

Treatment Options

Vestibular paroxysmia is similar to trigeminal neuralgia, a condition involving nerve pain. Treatment focuses on managing nerve compression and includes:

Medications:

• Sodium channel blockers: These drugs, such as Carbamazepine and Oxcarbazepine, are the first line of treatment. They work by reducing nerve irritation.

• • Carbamazepine: Initial dose is 100 mg twice daily, gradually increased to 200-600 mg/day as needed.
  • Oxcarbazepine: Dosage ranges from 300-900 mg/day.A therapeutic trial with these medications often confirms the diagnosis if symptoms improve.

• Note: Vestibular sedatives are generally not practical for this condition.

Surgery:

For patients with severe, persistent symptoms that do not improve with medication, surgery may be an option.

• Microvascular Decompression (MVD): This minimally invasive procedure involves:

1. 1. Identifying the vestibular nerve and the compressing blood vessels.
   2. Relieving pressure by cauterising the vessel or placing a tiny sponge between the nerve and the blood vessel.
   3. Performed endoscopically for precise results.

If you suspect vestibular paroxysmia, consult a healthcare professional for a thorough evaluation and treatment plan.