Vestibular paroxysmia (VP) is a rare vestibular disease characterized by brief attacks of spinning or nonspinning vertigo that last from around 1 second to a few minutes.1-5 Most attacks occur spontaneously, but they can be induced by turning the head to the right or left in the upright position. Arteries (or veins in rare cases) in the cerebellopontine angle are the pathophysiological cause of a segmental, pressure-induced dysfunction of the eighth nerve (primary VP). Cranial MRI should be performed to exclude the presence of other causes such as a tumor in the area of the cerebellopontine angle, arachnoid cysts, megalodolichobasilaris, brainstem plaques in multiple sclerosis, brainstem infarctions, or other brainstem lesions (secondary VP). A previous study found that 3 minutes of hyperventilation induced transient nystagmus in 70% of the patients with VP.2 However, the phenomenon was not considered the manifestation of a VP attack, instead being attributed to hyperirritability of the compressed vestibular nerve. We report a patient presenting with hyperventilation-triggered typical attacks of paroxysmal vertigo and nystagmus in VP.
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