Identifying central positional vertigo to prevent diagnostic pitfalls: A case series and review of literature

This case series highlights the critical role of radiological imaging in patients presenting with positional vertigo initially suggestive of benign paroxysmal positional vertigo (BPPV) but ultimately attributable to central nervous system pathology. The objective is to raise awareness among clinicians and paramedical professionals regarding the importance of early imaging when atypical clinical features are present....

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Clinicians evaluating positional vertigo should maintain a low threshold for neuroimaging when atypical features are present, as central causes can mimic BPPV and carry serious risk if misdiagnosed.

Distinguishing central positional vertigo from benign BPPV is critical to patient safety, and this case series reinforces the diagnostic value of radiological imaging in preventing missed or delayed central nervous system diagnoses.

1. 01Central positional vertigo can present identically to BPPV, creating significant diagnostic pitfall risk.
2. 02Radiological imaging (MRI/CT) is highlighted as a key tool for differentiating central from peripheral positional vertigo.
3. 03The case series is supported by a literature review of prior documented cases and imaging findings.
4. 04Missing a central cause of positional vertigo can lead to delayed treatment of serious neurological conditions.
5. 05Published in Radiology Case Reports (doi:10.1016/j.radcr.2026.07.009).

PMID

42564662

DOI

10.1016/j.radcr.2026.07.009.

Journal

Radiology Case Reports

Publication type

case_report

Evidence level

4

Population

Patients presenting with positional vertigo, including cases of central origin

Intervention

Radiological imaging (MRI/CT) for positional vertigo workup

Comparator

Clinical presentation consistent with BPPV