Res Vestib Sci.  2014 Jun;13(2):57-62.

Two Cases of Central Vertigo Presenting as Apogeotropic Direction Changing Positional Nystagmus

• Park MC
• Park JS
• Kim MB
• Ban JH

Abstract

Positional vertigo and nystagmus without focal neurological symptoms and signs are characteristic features of benign paroxysmal positional vertigo (BPPV). And the apogeotropic positional nystagmus can be diagnosed as cupulolithiasis of the horizontal semicircular canal. However, cerebellar lesion involving especially nodulus could be initially presented as positional vertigo like a BPPV without other neurologic signs. In most of the patients with cerebellar involvement, initial presentation shows dysarthria, ataxia, headache, nausea, vomiting and unsteadiness. But in some central lesions, positional nystagmus might be observed in head roll test as if BPPV was presented. It is very important for clinicians of dizziness care unit to differentiate central positional vertigo (CPV) from BPPV. But it is difficult to diagnose CPV at initial visit by history and physical exam only. Therefore, we introduce two cases with cerebellar infarction and hemorrhage initially presenting isolated positional vertigo mimicking BPPV.

Keyword

Cerebellum; Brain infarction; Benign paroxysmal positional verigo

MeSH Terms

Ataxia
Brain Infarction
Cerebellum
Dizziness
Dysarthria
Head
Headache
Hemorrhage
Humans
Infarction
Nausea
Neurologic Manifestations
Nystagmus, Physiologic*
Semicircular Canals
Vertigo*
Vomiting