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Treating Thrombosis of Intracranial Venous Sinuses Can Relieve Recurrent Refractory Paroxysmal Vertigo: Presented at ANA

By Jacquelyn Beals

WASHINGTON, DC -- October 12, 2007 -- Using a variety of treatment methods all directed toward the venous thrombosis, Mexican clinicians here at the Annual Meeting of the American Neurological Association (ANA) report effective relief for an unusual type of recurrent refractory paroxysmal vertigo.

Defined as a hallucinatory rotational movement disorder, vertigo is a common complaint. "In some cases, however, vertigo is a disabling symptom, recurrent in nature, with a poorly understood pathophysiological mechanism and resistance to treatment," the researchers noted, describing a study in which patients suffering from vertigo refractory to conventional therapies were treated.

Ricardo A. Rangel Guerra, MD, FACP, FAAN, FAHA, of the Grupo Vitaimagen, Monterrey, Mexico, co-authored this study, which involved 15 adult patients (8 females, 7 males) with recurrent refractory, paroxysmal vertigo. All 15 patients showed thrombosis of the intracranial venous sinuses.

In addition to paroxysmal vertigo, usually unrelated to postural changes, headache was a common complaint (9 patients). The Dix-Hallpike test, used in diagnosing benign paroxysmal positional vertigo, was applied to all 15 patients; 4 showed a positive (nystagmus) response.

Subjects received a variety of treatments, singly or in combination: superselective thrombolysis, anticoagulants, antiaggregants, heparin, or warfarin. In three patients, an endovascular prosthesis (stent) was placed in the lateral venous sinus or occluded vein.

Patients were followed for several months, and all responded well. Individual clinical courses ranged from "gradual improvement," to "marked improvement," to "100% control of vertigo." The vertigo disappeared in all patients, as did the associated headaches.

The authors propose an explanation for this vertigo of unusual Aetiology: "… the obstruction of the venous outflow from the inner ear due to the intracranial venous thrombosis … will increase the CSF pressure and the endolymph pressure within the semicircular channels, with the … mobilisation of the otoliths toward the crests of the channels triggering vertigo."

Treatment of the venous thrombosis, the group concluded, by any of a variety of methods, restores venous outflow and relieves the vertigo.


[Presentation title: Unusual Etiology of Recurrent Refractory Paroxysmal Vertigo. Experience with 15 Cases. Abstract M-21]

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