Case report: Vestibular paroxysmia: A diagnosis and treatment enigma

Patient: A 36-year-old female presented with a two-year history of persistent daily dizziness and positional vertigo. Each vertigo episode lasted less than one minute, occurring more than 20 times per day. Initially, she presented with bilateral tinnitus, which had reduced in intensity over time. Pure tone audiometry (PTA) showed bilateral mild sensorineural hearing loss. Both the Romberg and Fukuda tests were positive, with the patient falling to the right. She was swaying even with her eyes open. Ocular vestibular evoked myogenic potential (oVEMP) revealed right utricle dysfunction. Magnetic Resonance Imaging (MRI) of the brain and internal acoustic meatus (IAM) demonstrated a left Type I anterior inferior cerebellar artery (AICA) vascular loop and a right Type II AICA vascular loop. Her symptoms did not improve with betahistine She was started empirically on gabapentin, as carbamazepine was contraindicated due to the presence of the HLA-B*1502 gene Vertigo symptom scale has improved markedly from 42 to 25 VP is a rare, debilitating condition that may greatly reduce the quality of life and predisposes the sufferers to anxiety disorder. Due to its rarity, the diagnosis often missed. Although it is a diagnosis of exclusion, one must be aware of the possible diagnosis and adopt systemic approach to manage this case.