Painless vertebral artery dissection mimicking benign paroxysmal positional vertigo: a case report

Acute positional vertigo is a common neurological presentation, which is often assumed to be due to benign peripheral vestibular causes. This paper presents the case of a woman in her late 30s who presented with brief, recurrent, position-triggered vertigo. She had no headache, neck pain, trauma history, or vascular risk factors. The clinical history closely resembled benign paroxysmal positional vertigo....

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Audiologists and vestibular specialists should maintain a high index of suspicion for vascular causes of acute positional vertigo — particularly when red flags are absent — and refer urgently if clinical findings don't fully fit BPPV.

Vertebral artery dissection can be mistaken for BPPV even without the classic warning sign of neck or head pain, underscoring the need for careful red-flag screening in all acute vertigo presentations.

1. 01Vertebral artery dissection (a tear in a neck artery supplying the brain) can mimic BPPV without causing neck or head pain.
2. 02The absence of pain does not rule out a potentially life-threatening vascular event.
3. 03Case highlights the diagnostic risk of anchoring on BPPV in acute positional vertigo.
4. 04Neurological red-flag screening is essential before concluding a positional vertigo episode is benign.
5. 05Published as a case report in Annals of Medicine & Surgery (2026).

PMID

42583636

DOI

10.1097/MS9.0000000000005379.

Journal

Annals of Medicine & Surgery

Publication type

case_report

Evidence level

4

Sample size

1

Population

Single patient presenting with acute positional vertigo mimicking BPPV

Intervention

Diagnostic workup of acute positional vertigo