VESTIBULAR PAROXYSMIA (CASE REPORT, DISCUSSION)

Delva I. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Objective. To describe the clinical case of vestibular paroxysmia and thus demonstrate the importance of knowing the diagnostic criteria of VP. Results. Patient of male gender, 58 years old complained of attacks of intense vertigo lasting 15-20 seconds with a feeling of rotating objects counterclockwise. During an attack patient noted the crackling noise in the right ear, a feeling of instability, profuse sweat, nausea. Within next 10-15 minutes after the end of vertigo attack patient had a feeling of lightness in the head, palpitation, sensation of heat in the body. Attacks occur spontaneously, without any triggers, 5-7 times a month. The first attack happened 5 months ago while driving in the city, because of which patient almost got into a car accident. Since then, the patient has been afraid to drive. Patient is very afraid of attacks, because they are accompanied by a very unpleasant feeling of vertigo. In addition, patient worried that the attacks of vertigo could be a symptom of some severe unrecognized disease. He had no symptoms between the attacks except of constant high-pitched hissing tinnitus in both ears that got worse in silence. Patient consulted a neurologist who diagnosed benign paroxysmal positional vertigo. Patient was taking betahistine 24 mg twice a day for 1 month, phenibut 25 mg three times a day for 1 months. The treatment did not change the frequency and intensity of vertigo attacks. On neurological examination no abnormalities were found. Spontaneous or gaze-evoked nystagmus was not detected. A bedside head impulse test was negative. Equilibrium and coordination were intact. Dix-Hallpike test did not induce positional nystagmus. Hearing evaluation using tuning forks was unremarkable. Patient was asked to complete a hospital anxiety and depression scale: anxiety subscale score – 18 points, depression subscale score – 10 points. MRI brain showed non-specific white matter T2 hyperintense lesions in white matter around the ventricles of the brain (Fazekas grade 1). Audiometry diagnosed bilateral high-frequency sensorineural insufficiency. Electroencephalography did not show epileptiform activity. Otolaryngologist consultation: slight bilateral sensorineural hearing loss. In sum, clinical findings were consistent with the diagnosis of VP: A) At least ten attacks of spontaneous spinning or non-spinning vertigo. B) Duration less than 1 minute. C) Stereotyped phenomenology in a particular patient. D) Response to a treatment with carbamazepine/oxcarbazepine. E) Not better accounted for by another diagnosis. The patient was prescribed carbamazepine (200 mg once a day for 3 days, then 200 mg twice a day for 1 month) as pathogenetic treatment for VP and etifoxine hydrochloride (50 mg three times a day for 1 month) as anxiolytic drug. 1 month later at the visit, the patient reported no attacks during the treatment period. Hospital anxiety and depression scale: anxiety subscale score – 10 points, depression subscale score – 8 points. Patient recommended to use carbamazepine 100 mg twice a day for the next 3 months. 3 months later, at the follow-up visit, the patient reported only a single attack of mild vertigo during the last 3 months. It was recommended to continue taking carbamazepine 100 mg twice a day for 6 months, followed by a scheduled visit Conclusions. Neurologists need to know and actively use in their practice diagnostic criteria of VP.

vestibular paroxysmia,diagnostic criteria,etiopathogenesis,treatment

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«Bulletin of problems biology and medicine» Issue 1 (168), 2023 year, 171-175 pages, index UDK 616.28-008.5-07-08

10.29254/2077-4214-2023-1-168-171-175