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

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...

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Bibliographic Details
Published in:Neurological sciences 2020-02, Vol.41 (2), p.263-269
Main Authors: Joshi, Purwa, Mossman, Stuart, Luis, Leonel, Luxon, Linda M
Format: Article
Language:English
Subjects:
Adult
Aged
Benign
Benign Paroxysmal Positional Vertigo - diagnosis
Cerebellar Diseases - complications
Cerebellar Diseases - diagnosis
Cerebellar Diseases - pathology
Clinical Decision-Making
Diagnosis, Differential
Eye movements
Fatal Outcome
Female
Gait
Headaches
Heuristics
Humans
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Mimicry
Nausea
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Nystagmus
Nystagmus, Pathologic - diagnosis
Nystagmus, Pathologic - etiology
Nystagmus, Physiologic - physiology
Psychiatry
Radiation therapy
Review Article
Vertigo
Vestibular system
Vomiting
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Description
Summary: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.
ISSN:1590-1874
1590-3478
DOI:10.1007/s10072-019-04101-0