Cyclic vomiting syndrome associated with benign paroxysmal vertigo: a case report
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LETTER TO THE EDITOR
Cyclic vomiting syndrome associated with benign paroxysmal vertigo: a case report Sylvain Redon1 · Maya Elzière2 · Isabelle Lambert3 · Anne Donnet1,4 Received: 3 June 2019 / Accepted: 16 July 2019 © Belgian Neurological Society 2019
Keywords Cyclic vomiting syndrome · Benign paroxysmal vertigo · Episodic syndrome · Vestibular migraine Abbreviations IHS International Headache Society CVS Cyclical vomiting syndrome BPV Benign paroxysmal vertigo BPT Benign paroxysmal torticollis EEG Electroencephalogram VM Vestibular migraine Dear Editor, In the last classification of International Headache Society (IHS), four episodic syndromes associated with migraine are mentioned: cyclical vomiting syndrome (CVS), abdominal migraine, benign paroxysmal vertigo (BPV) and benign paroxysmal torticollis (BPT) [1]. These syndromes are thought to be entities of the same migrainous spectrum. They are distinguished by clinical features, duration of attacks and age of onset [2]. However, there may be some overlap and some features could be common. For example, a typical onset of symptoms upon arousal is a common feature between CVS and BPV. We report an unusual presentation of an episodic syndrome with stereotypical and predictable episodes of both vomiting and intense vertigo. We discuss clinical features borrowed from CVS and BPV in this observation.
* Sylvain Redon sylvain.redon@ap‑hm.fr 1
Department of Evaluation and Treatment of Pain, Clinical Neuroscience Federation, FHU INOVPAIN, CHU Timone, AP-HM, Marseille, France
2
Vertigo Center, European Hospital, Marseille, France
3
Clinical Neurophysiology, CHU Timone, AP-HM, Marseille, France
4
INSERM U-1107, Clermont‑Ferrand, France
A 22-year-old women, with familial history of migraine (second and third degree) reported episodes of vomiting and vertigo since the age of 2 years and 4 months. The first episode was initially considered as post-viral cerebellar ataxia, but next attacks occurred stereotypically, with a predictable periodicity, suggesting an episodic syndrome associated with migraine. This periodicity was of 2 months during childhood, then 3 months since adolescence, with a symptom-free interval between episodes. Attacks always began during sleep, in the middle of the night or early morning. The course of attacks was stereotypical, with a duration of 5 days. The clinical presentation was different between the two first days and the next 3 days. During the two first days, she was awakened by an episode of intense vertigo, sometimes associated with vomiting, lasting 30–60 min. She forced herself to get out of bed because she noticed that if she get back to sleep, vertigo could reappear. She became relatively asymptomatic until the next morning. The third, fourth and fifth days were particularly disabling, with intense nausea, vomiting and vertigo during day and night. On some days, vomiting could be absent, but vertigo remained disabling. Prodromal symptoms were reported (yawning, increased appetite, tiredness). During attacks, head
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