Table 1.

Timeline of the case reported.

2009	Patient had an episode of severe vertigo and vomiting. Symptomatic management with conservative medicine.
2011	Similar complaints recurred, consulted an ENT surgeon. Diagnosed with mild deafness in left ear and associated vertigo. Symptomatic management for vertigo. There was an erratic pattern of recurrence and remission till 2017.
2017	Frequent episodes of vertigo, vomiting with ringing sound in the left ear. She was diagnosed with Ménière's disease and initiated treatment for the same. However, her symptoms worsened incapacitating her to perform day to day activities. She underwent ayurvedic treatment from elsewhere.
15-04-2021	Admitted in our hospital for further management. Oral medicines started. Punarnavadi kashaya ([8], Kashaya kalpana) (15 ml added to 45 ml luke warm water twice daily before food), Chandraprabhavati [9] and Suvarnamuktadi gulika (One tablet each twice daily along with decoction)
22-04-2021 to 24-04-2021 (3 days)	Udwarthana (whole body massage with medicated powder) with Kolakulathadi churna ([10], Sutra Sthana, Aragwadheeyam adhyayam, Chapter 13 verse 118)
25-04-2021 to 27-04-2021 (3 days)	Abhyanga with Kshirabala taila ([11], Chikitsa Sthana, Vatashonita chikitsitham, Chapter 22 Versa 45–46) and Nadi sweda Vicharana snehapana with Kshirashadpala ghrira ([11], Chikitsa Sthana, Rajayakshmadi chikitsitham, Chapter 5 Versa 22–23) (30 g with rice gruel in lunch time)
28-04-2021	Virechana with Gandharvahastadi eranda taila ([12], Chikitsa Sthana, Vidradhivrdhichikitsa, Chapter 15, Verse 25.) - 30 ml at 6.00 AM
29-04-2021 to 05-05-2021 (7days)	Vairechanika nasya with shadbindu taila- 3 ml each nostril in the morning. But due to the probable SUNCT episode on day one, reduced to 2 ml each nostril for subsequent days. Thalam (applying medicated paste over bregma) with kshirabala taila and Rasnadi churna ([8], Churna Prakarana) Karna dhoopana with Laksha (slick serum from Laccifer lacca), Guggulu (Commiphora wightii (Arn.) Bhandari), Kushta (Saussurea lappa (Decne.) Sch.Bip.) and Karpura (Cinnamomum camphora (L.) J.Presl.) [13] in the evening.
06-05-2021 to 12-05-2021 (7 days)	Takradhara (pouring of medicated butter milk over scalp in a rhythmic fashion) ([8], Dhara kalpa) in the morning Karnapurana (medicated fumigation into ear canal) with Devadaru taila ([13], Uttara Sthana, Karnaroga Pratishedham chapter 18 verse 5) in the evening. Episode of vertigo on 08-05-2021 in the morning. Got relieved in 15 minutes.
September 2021	On telephonic follow up, the patient complained of frequent episode of vertigo even after full course of treatment from this institute. Took ENT consultation and was on Tab Vertin 48 mg and Tab Diamox twice daily. Since she had no relief, cardiac and neurological evaluation was conducted. Was under Tab Gabapentin 200 mg twice daily. But still experinced sudden vertigo attack in between. Her MRI findings on 18-09-2021 showed bilateral anterior inferior cerebellar artery (AICA) loop–AICA loop within the left internal acoustic canal extending >50% into the IAC (internal acoustic canal) (Type III Chavda). AICA loop in the right cerebello-pontine angle bordering the right internal acoustic meatus and not entering the IAC (Type I Chavda).She is under further investigations to find out the cause for vertigo, in a higher medical center.