Positional vertigo is a frequent complaint in otology and vestibular physiotherapy, arising from functional or structural causes affecting the peripheral or central vestibular systems. Although benign paroxysmal positional vertigo (BPPV) is the most common form, other etiologies such as vestibular paroxysmia (VP), central positional vertigo, or vertebrobasilar insufficiency should be considered....
✦ The floor
Discussion
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Clinicians should consider vestibular paroxysmia in patients with apparent superior-canal BPPV that does not respond to repositioning maneuvers, especially when neuroimaging reveals a neurovascular conflict; no change to routine BPPV management protocols is warranted based on a single case report.
Misdiagnosing vestibular paroxysmia as BPPV can lead to repeated ineffective repositioning maneuvers and delay appropriate pharmacological or surgical treatment, making accurate differential diagnosis critical for patient outcomes.
- 01A patient presented with positional vertigo mimicking superior semicircular canal BPPV but had neurovascular conflict on imaging.
- 02The underlying diagnosis was vestibular paroxysmia — a nerve-compression disorder, not a crystal-displacement problem.
- 03Superior semicircular canal BPPV is rare and its presentation can closely resemble vestibular paroxysmia.
- 04MRI neuroimaging showing neurovascular conflict is a key differentiator when clinical diagnosis is uncertain.
- 05Literature review highlights the challenge of positional vertigo differential diagnosis in atypical presentations.
Vestibular paroxysmia can mimic BPPV of the superior semicircular canal in its clinical presentation.
studypartially supportedNeurovascular conflict identified on neuroimaging can be associated with vestibular paroxysmia causing positional vertigo.
studysupported- PMID
- 42855708
- DOI
- 10.1186/s13256-026-06552-4.
- Journal
- Journal of Medical Case Reports
- Publication type
- case_report
- Evidence level
- 4
- Sample size
- 1
- Population
- Single patient presenting with positional vertigo and neurovascular conflict on neuroimaging
- Intervention
- Clinical evaluation and neuroimaging for differential diagnosis of positional vertigo
Primary outcomes
Accurate differential diagnosis between vestibular paroxysmia and BPPV of the superior semicircular canal; Identification of neurovascular conflict as an underlying cause of positional vertigo