Benign Paroxysmal Vertigo of Childhood

Abstract

\s=b\ Thirty-three cases of benign paroxysmal vertigo in childhood have been seen at our institution since the disorder was recognized ten years ago. Progression from paroxysmal torticollis of infancy to paroxysmal vertigo of childhood is documented. Ear infections and allergy appeared causative in a few, but not most, of the cases. The most important consideration for the pediatrician is to rule out epilepsy and brain tumor. Parents should be reassured that the condition is benign, and that the attacks will cease in a few months or years.Benign paroxysmal vertigo (BPV) of childhood is a disorder charac¬ terized by brief attacks of vertigo in small children. It is often mistaken for epilepsy, or confused with early signs of a brain tumor. First described in the neurological literature,1 -this con¬ dition has received little attention in pediatrie journals.1" We believe that this is not a rare disorder, and that pediatricians need to be aware of it; therefore, we present our experience with BPV. REPORT OF CASESIn the ten years since Basser's original description,' we have seen 33 patients at the Ochsner Clinic whose illness met most of the following criteria: (1) multiple, brief, sporadic episodes of disequilibrium, anxie¬ ty, and often nystagmus or vomiting; (2) normal neurologic examination; (3) normal electroencephalogram; and (4) abnormal response to caloric stimulation of the ears.Of the 33 patients, 19 were girls and 14 boys. The onset of vertigo was most often between 1 and 3 years of age. Four children began having attacks in the first year, nine in the second year, 11 in the third year, three in the fourth year, and the remaining six after the fourth year. The children generally had from one to four attacks of vertigo per month. One child had attacks more often than weekly, and five had less than one per month. Several children would have clusters of attacks. In 17 cases, the attacks were brief, lasting less than five minutes, sometimes only a few seconds. In ten cases, attacks would last from five to ten minutes, and in six cases the mothers noticed that occasional attacks would last longer than ten minutes.All attacks occurred suddenly, and with¬ out apparent provocation or prodrome. The children would usually appear frightened, and cry out for help. Some would cling to their parents or to furniture for support. Others would fall, or stagger drunkenly with the attacks. Pallor and sweating were common. Vomiting during the attacks occurred in seven patients. Nystagmus was noted in eight children, and torticollis in ten. The attacks would end quickly, and the children appeared to be completely healthy between spells. Many children, although young, were able to describe definite rota¬ tional sensations. One 2-year-old would say "round, round" during the attacks, and "all gone" at the end of the attack. Eight patients felt the room, floor, or world was spinning, three said they were rotating, two reported a sensation of falling. Five said they felt dizzy, and one said he was "earachy." General physical ex...

Benign paroxysmal vertigo of childhood: A review of the literature

“…Also, children's migraine attacks are often more frequent, of shorter duration (lasting less than 2 h) (35), may not be experienced as throbbing (35), and may present with a less clearly defined pattern of prodromal expression. Bilateral head pain is common, as opposed to the unilateral headache of classic migraine in adults (34,36,37).…”

Torcicolo paroxístico benigno da infância: diagnóstico e evolução clínica de seis pacientes

“…Apenas um de nossos pacientes evoluiu posteriormente com crises de tonturas, dificuldade para manter-se em pé e deambular, porém sem desvios da cabeça, por cerca de um ano; e tendo apresentado desde então crises mensais de cefaléia com características de enxaqueca. Isto está de acordo com o que foi observado previamente por Dunn e Snyder, que já sugeriam que a TBPI fosse pre- cursora da vertigem paroxística benigna (VPB) 8 . Vários autores 8,9 relacionam o TPBI como possível precursor de enxaqueca ou de até mesmo terem essas patologias a mesma origem fisiopatológica 10 .…”

“…Isto está de acordo com o que foi observado previamente por Dunn e Snyder, que já sugeriam que a TBPI fosse pre- cursora da vertigem paroxística benigna (VPB) 8 . Vários autores 8,9 relacionam o TPBI como possível precursor de enxaqueca ou de até mesmo terem essas patologias a mesma origem fisiopatológica 10 . Dois de nossos pacientes (casos 3, 5 e 6) evoluíram com enxaqueca, cinco dos pacientes apresentavam história em que pelo menos um dos pais tinha enxaqueca.…”

Benign Paroxysmal Vertigo in Childhood: A Migraine Equivalent

“…After the original and masterly descrip tion given by Basser in 1964, cases of BPV in children have been reported with increasing frequency [Fenichel, 1967;Koenigsberger et al, 1970;Watson and Steele, 1974;Dunn and Snyder, 1976;Eviatar and Eviatar, 1977;Vercelletto et al, 1979;Koehler, 1980;Eeg-Olofsson et al, 1982;Dalla Bernardina et al, 1982;Viani et al, 1982]. However, the disor der probably has been previously described, for example by Lerique-Koechlin et al [1961], without the precise nosological char acterization given by Basser [1964],…”