Treatment of Central Vertigo With Low Dose Olanzapine: Report of Two Cases

Abstract

Good treatments are available for many cases of vertigo due to a peripheral cause such as benign paroxysmal positional vertigo. Conversely, vertigo secondary to a central lesion remains a treatment challenge typically without good pharmacologic or other treatments. We have successfully treated two patients, the first to our knowledge, with central vertigo, one from brain injury, one after stroke, with low dose olanzapine which we found to quickly and dramatically resolve vertigo and permit functional normalization. In our two cases, we found that a low dose of olanzapine 2.5mg daily (typical dosing of olanzapine for the psychiatric disease is 5-20mg daily) caused vertigo to rapidly and dramatically remit. Interestingly, our two cases had different causes and possibly lesion locations.

Keywords: central; olanzapine; peripheral; treatment; vertigo.

Figure 1. CT of the first patient

Left panel: axial view CT shows bullet trajectory and left cerebellar hemisphere (arrow) encephalomalacia, streak artifact from a retained bullet fragment. Right panel: sagittal view CT shows bullet trajectory through left cerebellar hemisphere (arrow) with associated encephalomalacia.

Figure 2. MRI of the second patient

Left panel: T1 weighted images of the second patient showed acute infarcts in the right periventricular white matter (arrow). Right panel: T1 weighted images of the second patient showed acute infarcts in the left medulla (arrow).