Vertigo in Vestibular Schwannoma Patients Due to Other Pathologies

Abstract

Objective: To report findings from a cohort of vestibular schwannoma (VS) patients presenting with vertigo from a secondary comorbid vestibular disorder; and to discuss management strategies for this subset of patients presenting with both episodic vertigo and VS. Patients: All VS patients who presented with vertigo as the primary symptom from 2012 to 2015 and endorsing no other major complaints were examined. Intervention: Treatment with migraine lifestyle and prophylactic therapy, or Epley maneuver. Main Outcome Measure: Resolution of vertigo following medical treatment alone. Results: Of the nine patients studied, seven (78%) suffered from vestibular migraine, and two (22%) experienced benign positional vertigo. All patients experienced complete resolution of symptoms after treatment. As a result of symptomatic improvement, seven patients (78%) avoided surgery in favor of observation, while two patients (22%) underwent radiosurgery due to continued tumor growth and other nonvertigo symptoms. Conclusion: VS patients can sometimes present with a history of recurrent episodic vertigo. The etiology of the vertigo could be due to the tumor itself or may be due to an underlying comorbidity such as vestibular migraine or benign positional vertigo. VS patients presenting with vertigo should undergo a standard vertigo history and examination to identify other potential causes of vertigo. Most VS patients in our cohort avoided intervention and had resolution of their vertigo.

Independent Predictors of Recurrence of Vertigo Among Nigerians

“…Correct diagnosis enhances appropriate intervention and resolution of vertigo. [19] While the resolution of vertigos appears to be common, recurrence can occur for various reasons. Recurrent attack of vertigo has been reported to be usually milder than that of the previous attack, [12] but it can be associated with fear, anxiety and psychological distress.…”

Vestibular Migraine Following Radiosurgery for Vestibular Schwannoma

“…Dizziness in VS patients is a commonly experienced symptom that could be related to a variety of causes other than the tumor itself. In a retrospective cohort study on examining secondary causes of vertigo in VS patients at a tertiary center, Sahyouni et al found that 78% had comorbid VM [11]. Therefore, it is imperative to evaluate dizziness in VS patients using a wide differential diagnosis as part of their workup and treatment.…”

“…Lee et al report that 32% of VS patients developed vestibular dysfunction within six months of SRS [18]. This highlights the importance of dizziness evaluation and treatment as part of the comprehensive management of VS. A recent interventional study reports that all patients with VS and comorbid VM had complete symptomatic resolution of their vertigo after being treated with migraine prophylactic therapy (e.g., verapamil, topiramate, nortriptyline) and undergoing migraine diet and lifestyle changes [11]. In a non-placebo randomized controlled trial, both venlafaxine and propranolol were found to reduce vertigo episodes and severity in VM patients.…”

Symptoms: Sudden Hearing Loss and Vertigo

“…A complete history, CT scan, and audiometry are used for diagnosis, and treatment usually consists of surgical repair. 1 Treatment is best performed using an intratympanic blood patch and if unsuccessful potentially surgical repair. 2…”