Vestibular Paroxysmia: A Four-Case Report

Vestibular paroxysmia (VP) is a rare vestibular syndrome classified as a neurovascular compression disorder. It arises from chronic compression of the vestibulocochlear nerve caused by a vascular loop, leading to demyelination via ephaptic transmission. The diagnosis primarily relies on a thorough medical history that meets specific criteria. The differentiation between definite and probable VP is based on the response to medications such as carbamazepine or oxcarbazepine. In this report, we present four patients over the age of 40 who experienced recurrent, brief episodes of vertigo, either spontaneously or triggered by head movements. These patients had undergone various treatments without success. Subsequent MRI scans revealed neurovascular compression of the VIII cranial nerve, prompting the prescription of oxcarbazepine, which resulted in a positive response in all cases. Although the differential diagnoses for these symptoms are limited, the rarity of VP can complicate diagnosis. Therefore, a trial of treatment should be considered in appropriate cases.