Vertigo or dizziness as the first presentation oepilepsy: A case report

Abstract

Vertigo or dizziness is a common neurological symptom, but it is rarely regarded as the first presenting symptom of epilepsy. Patients who present with vertigo as the first symptom of epilepsy may be misdiagnosed or missed diagnose. We report a case presenting with vertigo or dizziness as the first manifestation of epilepsy and review relevant literature. A 71-year-old female patient sought medical attention in view of paroxysmal dizziness for a year that progressively worsened over the course of 1 week. Initially, her dizziness occurred 2 or 3 times a month, lasting for less than a minute each time. However, her attacks became more frequent and severe over the course of 1 week. Twenty-four-hour electroencephalogram (EEG) monitoring showed spike-and-slow-wave complex discharges at both sphenoidal electrodes, with the left being more prominent. The patient was treated with oral valproic acid. After a 9-month follow-up, the frequency of dizziness was markedly reduced. Although the pathogenesis of epileptic vertigo remains ambiguous, the current literature indicates that vestibular cortical neurons may be closely associated with periodic abnormal discharge of the brain lobe. Based on comprehensive medical history and EEG results, we should exercise caution when diagnosing this kind of epilepsy.