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Central Conditions Mimicking Benign Paroxysmal Positional Vertigo

A Case Series

Power, Laura BPhysio; Murray, Kate PhD; Bullus, Kristian; Drummond, Katherine J. MBBS, MD, FRACS; Trost, Nicholas MBBS, FRANZCR, MPH; Szmulewicz, David J. PhD

Journal of Neurologic Physical Therapy: July 2019 - Volume 43 - Issue 3 - p 186–191
doi: 10.1097/NPT.0000000000000276
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Background and Purpose: Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. The term “benign” is consistent with a peripheral vestibular disorder that does not carry the potentially sinister sequelae of a central nervous system (CNS) cause. However, in 12% to 20% of cases, positional vertigo may be attributed to CNS pathology, including tumors of the cerebellum.

Case Description: Here, we present a series of 3 cases in which positional vertigo and nystagmus were the only presenting features in 2 cases of cerebellar tumor and 1 case of obstructive hydrocephalus.

Intervention: All patients underwent surgical intervention for removal of posterior fossa tumors or posterior fossa decompression for obstructive hydrocephalus. Following surgery, all 3 patients underwent a period of vestibular rehabilitation for postoperative motion sensitivity and balance impairment.

Outcomes: Despite the continuing presence of central positioning nystagmus, all 3 patients recovered well, putatively with the aid of vestibular rehabilitation.

Discussion: The presence of central positioning nystagmus may be the sole presenting feature of serious neurological conditions such as posterior fossa tumor. It is recommended that a diagnosis of BPPV can only be made if Dix-Hallpike or supine roll maneuver elicits nystagmus that is consistent with BPPV. Any features of the nystagmus, which are not consistent with BPPV, should raise suspicion of central pathology, and warrant further investigation.

Video Abstract available for more insights from the authors (see Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A265).

Balance Disorders and Ataxia Service, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia (L.P., D.J.S.); Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (L.P., D.J.S.); Dizzy Day Clinics, Melbourne, Australia (L.P., K.M.); Department of Neurosurgery (K.B.) and Medical Imaging Department (N.T.), St Vincents Hospital, Melbourne, Australia; Department of Neurosurgery, Royal Melbourne Hospital, and Department of Surgery, University of Melbourne, Australia (K.J.D.); and Neuroscience Department, Cerebellar Ataxia Clinic, Alfred Health, Melbourne, Australia (D.J.S.).

Correspondence: Laura Power, BPhysio, The Royal Victorian Eye and Ear Hospital, Balance Disorders and Ataxia Service, 2 St Andrews Place, East Melbourne, VIC 3002, Australia (laura_power@live.com.au).

This case series has been previously presented at the Neuro-Otology Society of Australia annual conference in 2017.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

© 2019 Academy of Neurologic Physical Therapy, APTA