Central mimics of benign paroxysmal positional vertigo: an illustrative case series

  • Purwa JoshiEmail author
  • Stuart Mossman
  • Leonel Luis
  • Linda M Luxon
Review Article


Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder that is diagnosed based solely on clinical findings. Rarely, central lesions can present with positional vertigo and nystagmus, mimicking BPPV. Recognised red flags that may help distinguish central mimics from BPPV include the presence of additional neurological symptoms and signs, atypical nystagmus patterns, and the absence of a sustained response to repositioning manoeuvres. We present seven cases that illustrate how heuristic bias may affect the detection of these features in practice. Furthermore, our cases suggest that isolated downbeat positional nystagmus (simulating anterior canal BPPV) and apogeotropic horizontal nystagmus on the supine roll test (simulating horizontal canal BPPV) should be considered additional red flags.


Clinical neurology Nystagmus Vertigo 


Compliance with ethical standards

Ethical standards statement

National Ethics Advisory Committee’s ethical guidelines for health and disability research in New Zealand were followed.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.Department of NeurologyWellington HospitalWellingtonNew Zealand
  2. 2.Department of OtolaryngologyCentro Hospitalar Lisboa NorteLisbonPortugal
  3. 3.Ear InstituteUniversity College LondonLondonUK

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