Abstract
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.
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References
Baloh RW, Halmagyi GM (1996) Disorders of the vestibular system. Oxford University Press
von Brevern M, Bertholon P, Brandt T et al (2015) Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res 25(3–4):105–117
von Brevern M, Radtke A, Lezius F et al (2007) Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 78(7):710–715
Aw S, Todd M, Aw G, McGarvie L, Halmagyi G (2005) Benign positional nystagmus: a study of its three-dimensional spatiotemporal characteristics. Neurology 64(11):1897–1905
Bronstein AM, Hood JD (1985) Cervical nystagmus due to loss of cerebellar inhibition on the cervico-ocular reflex: a case report. J Neurol Neurosurg Psychiatry 48:128–131
Zee D, Friendlich A, Robinson D (1974) The mechanism of downbeat nystagmus. Arch Neurol 30(3):227–237
Grant G, Aschan G, Ekvall L (1964) Nystagmus produced by localized cerebellar lesions. Acta Otolaryngol 58(Suppl 192):78–84
Choi J, Kim J, Kim H, Glasauer S, Kim JS (2015) Central paroxysmal positional nystagmus: characteristics and possible mechanisms. Neurology 84(22):2238–2246
Jacobson G, Butcher J, Newman C, Monsell E (1995) When paroxysmal positioning vertigo isn’t benign. J Am Acad Audiol 6:346–349
Johkura K (2007) Central paroxysmal positional vertigo: isolated dizziness caused by small cerebellar hemorrhage. Stroke 38:e26–e27
Yang T, Oh S (2014) Geotropic central paroxysmal positional nystagmus in a patient with human immunodeficiency virus encephalopathy. J Neuroophthalmol 34:159–161
Lee J, Lee W, Kim J, Kim HJ, Kim JK, Jeon BS (2009) Perverted head-shaking and positional downbeat nystagmus in patients with multiple system atrophy. Mov Disord 24(9):1290–1295
Comacchio F, Mion M, Markova V (2017) Late cerebellar vermis metastasis of breast cancer presenting as pseudo-benign paroxysmal positional vertigo. J Case Rep Stud 4(6):604
Jen J, Yue Q, Karrim J et al (1998) Spinocerebellar ataxia type 6 with positional vertigo and acetazolamide responsive episodic ataxia. J Neurol Neurosurg Psychiatry 65:565–568
Dunniway H, Welling B (1998) Intracranial tumors mimicking benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 118(4):429–436
Klein J (2005) Five pitfalls in decisions about diagnosis and prescribing. BMJ 330:781–784
Macdonald N, Kaski D, Saman Y et al (2017) Central positional nystagmus: a systematic literature review. Front Neurol 20(8):141
Pollak L, Pollak E (2014) Headache during a cluster of benign paroxysmal positional vertigo attacks. Ann Otol Rhinol Laryngol 123(12):875–880
Vannucchi P, Pecci R, Ginnoni B (2012) Posterior semicircular canal benign paroxysmal positional vertigo presenting with torsional downbeating nystagmus: an apogeotropic variant. Int J Otolaryngol 2012:413603. https://doi.org/10.1155/2012/413603
Lechner C, Taylor R, Todd C et al (2014) Causes and characteristics of horizontal positional nystagmus. J Neurol 261(5):1009–1017
Kishi M, Sakakibara R, Yoshida T, Yamamoto M, Suzuki M, Kataoka M, Tsuyusaki Y, Tateno A, Tateno F (2012) Visual suppression is impaired in spinocerebellar ataxia type 6 but preserved in benign paroxysmal positional vertigo. Diagnostics (Basel) 2(4):52–56
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Joshi, P., Mossman, S., Luis, L. et al. Central mimics of benign paroxysmal positional vertigo: an illustrative case series. Neurol Sci 41, 263–269 (2020). https://doi.org/10.1007/s10072-019-04101-0
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DOI: https://doi.org/10.1007/s10072-019-04101-0