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Advanced Ne
Advanced Neurologyurology A case report of epileptic vertigo

by heavy-headedness, floating sensation, and instability impulse test, head thrust test, and caloric reflex test were
when walking. Originally, her dizziness would occur 2 or all negative. Twenty-four-hour electroencephalogram
3 times a month, with each episode lasting for less than a (EEG) monitoring showed spike and slow wave complex
minute. However, over a course of 1 week, she experienced discharges occurring at both sphenoidal electrodes, with
more frequent (≥5 times a day) and severe episodes of the left being more prominent (Figure 1). Oral sodium
vertigo. Her symptoms were unpredictable and unrelated valproate (500 mg/day) was administered and the dosage
to position change. She did not experience any intense was increased to 1000 mg/day after a week. A 9-month
spinning sensation during the onset of vertigo, nor was the follow-up showed that the patient had no further episodes
dizziness accompanied by hallucination, unconsciousness, of paroxysmal dizziness.
headache, orbital discomfort, sweating, nausea, vomiting,
abdominal pain, or diarrhea. She had no flustered feelings, 3. Discussion
chest tightness, palpitations, pruritus over her abdomen, Epileptic vertigo is a rare form of epilepsy. The incidence
or abdominal discomfort, including “ascending epigastric of epilepsy presenting with vertigo or dizziness is only
sensation.” There were no concurrent neurological, about 8.5%. Especially, the sole symptom of vertigo
ophthalmic, or auditory disorders. She did not experience or dizziness, which is rarely reported in the literature,
agoraphobia, panic attacks, or any recent stressful only occurs in approximately 0.8% of all epilepsy . Its
[3]
situations. She had a previous history of lumbar disk incidence is higher in children and adolescents compared
herniation more than 4 years ago, and she denied history of with adults, especially in female . Due to the differences in
[7]
hypertension, coronary heart disease, and diabetes. She had race, sample size, etiology, and evaluation criteria between
no history of motion sickness, migraine, trauma, surgery, different studies , a complete and consistent criterion for
[3]
or diseases that resulted in epileptic seizures. Personal epileptic vertigo has yet to be established.
history and family history were insignificant. Physical
examination showed that her general condition was good. Although the pathogenesis of epileptic vertigo remains
Cardiovascular, respiratory, abdominal, and nervous system elusive, the current literature has indicated that vestibular
examinations were normal. No abnormalities observed cortical neurons are associated with periodic abnormal
[8,9]
in vestibular and cerebellar function examinations. Her discharge of the brain lobe . Vestibular symptoms may also
temperature and hearing examination were normal. occur as a result of the permanent damage of the vestibular
[10]
The laboratory investigation results were as follows: cortical area due to chronic epilepsy . The hallmarks of
C-reactive protein (CRP), liver function, kidney function, epilepsy, including paroxysmal, transient, stereotypical,
blood lipid, blood glucose, electrolytes, homocysteine, and repetitive, are also present in epileptic vertigo. Its main
thyroid function, erythrocyte sedimentation rate (ESR), clinical manifestations are recurrent attacks of dizziness and
coagulation function, protein S, protein C, antinuclear vertigo, accompanied by the rotation of the visual scene, with
antibodies (ANAs), antiphospholipid antibodies, and or without nausea, vomiting, pallor, sweating, palpitation,
antiganglioside antibodies were all within the normal headache, and so on. These symptoms are unpredictable
range. Serologic tests for human immunodeficiency and are not associated with positional variation. With each
virus (HIV), hepatitis B/C, and cytomegalovirus were all episode, there is no loss of consciousness. Some patients
negative. There were no obvious abnormalities in chest may present with peripheral illusion sensation, such as
radiograph, echocardiogram, abdominal ultrasound, and rotating, drifting, tilting, swaying, heavy headedness, and
electrocardiogram examinations. Brain magnetic resonance unsteadiness while walking.
imaging (MRI) showed old lacunar cerebral infarction Each attack varies from several seconds to minutes
lesions. Evaluation of intracranial and extracranial without an exact time. However, studies have reported
large vessels such as carotid ultrasound, computerized that the duration of almost all temporal lobe-associated
tomography angiography (CTA), and magnetic resonance vertigos usually lasts less than a minute, whereas that
angiography (MRA) did not show obvious stenosis nor of non-temporal lobe-associated vertigo lasts longer .
[3]
atherosclerotic plaque. Hyperventilation did not trigger This may indicate that the temporal lobe is associated
the onset of the dizziness, and no spontaneous nystagmus with transient epileptic vertigo. Hence, missed diagnosis
was observed during the episode. On otolaryngology or misdiagnosis with transient ischemic attacks (TIA),
examination, her ear canals and eardrums were normal. vestibular migraine, Meniere’s disease, BPPV, vestibular
In addition, tests for benign paroxysmal positional vertigo paroxysmia, hypoglycemia, arrhythmia, panic attacks,
(BPPV) such as bilateral Dix-Hallpike maneuver, supine neurosis, somatization, or psychogenic dizziness may
roll test, Unterberger test, bilateral Dix-Hallpike maneuver, likely occur in such patients. In EEG, abnormalities are
supine roll test, Unterberger test, fistula test, video head mainly observed in the frontal, temporal, and top area of

Volume 1 Issue 3 (2022) 2 https://doi.org/10.36922/an.v1i3.140