ABSTRACT
CASE PRESENTATION This 44-year-old man began to experience episodes of vertigo, dysarthria, and ataxia while a teenager. The spells typically occurred during physical exertion such as bowling. Later, in his 20s and 30s, they occurred while under pressure at his job in a factory. At first, each episode lasted 15-20 minutes, but over time, they began to last as long as 1-2 hours. The episodes occurred at an average frequency of 4-6 times per year, with no residual symptoms between attacks. He was evaluated by the neurology department in his 20s, but no diagnosis could be made. He was then referred to otolaryngology who attributed his spells to a cholesteatoma, which was not found after exploratory surgery. Other diagnoses considered included basilar invagination, convulsive disorder, and anxiety attacks. Further history revealed that his mother had similar spells, which were especially common while working but were reduced in frequency after her retirement. His daughter, age 20, experienced similar episodes occurring twice a week and lasting approximately 15 minutes. Examination of the patient revealed no neurologic abnormalities with the exception of gaze-evoked nystagmus on right or left horizontal gaze.
