Abstract text (incl. figure legends and references)
Vestibular migraine (VM) is a complex disorder with an estimated prevalence of 1-3%.1 VM is most common cause of recurrent spontaneous vertigo.2 During acute VM attacks spontaneous and positional nystagmus can be seen.3 This case of vertigo and nystagmus may be misdiagnosed as BPPV or Meniere disease.
A 10 years old girl visited our clinic with her parents complaining of abnormal eye movement with vertigo. She had a history of headache from 3 years ago that were unilateral, in temporal region. She has photophobia. Headache were aggravated by activity and had severe intensity. After starting the headache patient had a vertigo that caused imbalance which lasts 10-60 minutes. During the vertigo her parents reported abnormal eye movement, which documented by camera. Videos showed pendular nystagmus. Patient was fully awake and aware during the attacks. Attacks occur about three times in the month and between them patient is symptom free. She had cyclic nausea and vomiting until 6 years old, that improve spontaneously. All neurologic exams was normal. In MRI she has a few nonspecific bilateral asymmetrical lesions. According to the history and IHC-3, vestibular migraine was made as diagnosis. Patient undergone treatment with Cinarizin 25 mg which resulted in reduction of attacks in 3 months follow-up (only one which was following an emotional stress).
This case illustrates that Observation of the nystagmus during a vertigo attacks is helpful for correct diagnosis. exact history taking is important for VM diagnosis, differentiate VM from BPPV, and exclusion CNS consideration.
1.Systematic review of prevalence studies and familial aggregation in vestibular migraine, Ana Paz-Tamayo et al, Frontiers in genetics, 2020
2.Diagnosis and treatment in vestibular migraine, Pinar Yalinay Dikmen, Turkish journal of Neurology,2020
3.Acute migrainous vertigo: clinical and oculographic finding, Michael von Brevern et al, Brain,2005