Paroxismia vestibular: estudo clínico e tratamento de oito pacientes

Abstract

RESUMO -A paroxismia vestibular é uma síndrome de compressão do VIII nervo craniano e foi denominada inicialmente por Janetta "vertigem posicional incapacitante". Esta síndrome é caracterizada por episódios c u rtos de vertigem, zumbido, déficit vestibular e auditivo. A RM pode mostrar compressão do VIII nerv o por vasos da fossa posterior, como a artéria basilar, artéria vertebral, artéria cerebelar inferior anterior, artéria cerebelar inferior posterior. A paroxismia vestibular pode ser tratada com terapia medicamentosa tais como carbamazepina, fenitoína ou gabapentina, ou com descompressão microvascular do VIII nervo. Este estudo descreve oito pacientes com paroxismia vestibular. Quatro deles mostraram também sinais clínicos sugerindo compressão do V e/ou VII nervos. Sete pacientes tratados com carbamazepina tiveram melhora significativa da vertigem e zumbido.PALAVRAS-CHAVE: vertigem, nervo vestibular, diagnóstico, tratamento. Vestibular paroxysmia: clinical study and treatment of eight patientsABSTRACT -Vestibular paroxysmia is a syndrome of cro s s -c o m p ression of the VIII cranial nerve and was first described by Jannetta who used the term "disabling positional vertigo". This syndrome is characterized by brief attacks of vertigo, tinnitus, vestibular and auditory deficits. MRI may show the VIII nerve compre s s i o n f rom vessels in the posterior fossa, such as the basilar, vertebral, anterior-inferior cerebellar or the posteriorinferior cerebellar arteries. Vestibular paroxysmia may be treated either with medical therapy, such as carbamazepine, phenytoin or gabapentin or with the microvascular decompression of the VIII nerve. This study describes eight patients with vestibular paroxysmia. Four of them showed also clinical signs suggesting c ro s s -c o m p ression of the V and/or VII nerve. Seven patients treated with carbamazepine had significant improvement of vertigo and tinnitus.

Referral and Final Diagnoses of Patients Assessed in an Academic Vertigo Center

“…In selected cases, auxiliary vestibular tests (e.g., caloric testing), blood works (e.g., autoimmune markers), or imaging (e.g., MRI) may be required, while in others clinical evaluation alone is sufficient (Colledge et al, 1996; Kanashiro et al, 2005; Craighero et al, 2011; Jahn and Dieterich, 2011). …”

“…The most frequent disorders causing dizziness, such as BPPV, vestibular neuritis, Ménière’s disease, and vestibular migraine, are usually accessible to treatment (Kanashiro et al, 2005; Lopez-Escamez et al, 2005; Sajjadi and Paparella, 2008; Strupp and Brandt, 2009; Mendel et al, 2010; Strupp et al, 2011). Similarly, cerebro-vascular disorders, which are the most common central causes of dizziness, are treatable by acute, e.g., thrombolytic, or prophylactic, e.g., anti-thrombotic, measures (Karatas, 2008).…”

“…So far, epidemiologic studies were restricted to dizzy patients seen either by general practitioners (Sloane, 1989; Nazareth et al, 1999) or in specialized neuro-otological centers (Kanashiro et al, 2005). However, to our knowledge, neuro-otological diagnoses made by general practitioners were not compared to those made by specialists.…”

Phenytoin in the Treatment of Osmophobia in Migraine Patient: A Case Report

“…However, it is also used to treat idiopathic trigeminal neuralgia and vestibular paroxysmia [23]. The risks of its long-term use include gingival hypertrophy [24] and cognitive changes [25].…”

Vertigo in Cerebrovascular Diseases

“…Vestibular paroxysmia results from cross compression of the vestibular nerve by a vascular loop usually the basilar, vertebral, anterior inferior cerebellar or the posterior-inferior cerebellar arteries. There are brief attacks of vertigo, tinnitus, vestibular and auditory deficits termed disabling positional vertigo by Jannetta 44,45. …”