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Vestibular Paroxysmia

Typical Symptoms of Vestibular Paroxysmia – Diagnosis – Treatment with Carbamazepine

Vestibular Paroxysmia


Vestibular Paroxysmia presents with very brief attacks of vertigo lasting for seconds and recurring multiple times per day. The attacks can be provoked by hyperventilation in 70 % of patients. In Vestibular paroxysmia hyperventilation induced rapid eye movements (nystagmus) is observed as well.


No decent theory about the cause of this type of vertigo exists. Similar to trigeminal neuralgia mechanism of vestibular paroxysmia has been suggested but never been proven. The guess is that the vestibular nerve is irritated by a pulsating vascular loop positioned closely to the vestibular nerve root.

Diagnosis and Treatment

Neurological abnormalities and diagnostic testing do not reveal anything abnormal in between the attacks. The diagnosis may be confirmed by triggering the vertigo attacks and/or nystagmus by hyperventilation in 70%.

Vertigo attacks are predictably controlled by low dose Carbamazepine (Tegretol). Response to Carbamazepine also has some diagnostic value because no other vertigo would respond to a low dose of this medication.

The attacks of vertigo may remit spontaneously.

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