Vestibular Paroxysmia Presenting With Atypical Positional Nystagmus Resembling Benign Paroxysmal Positional Vertigo

A 69-year-old man presented with recurrent vertigo triggered by positional changes, left aural fullness, and left hemifacial spasm. The supine roll test showed direction-changing apogeotropic horizontal nystagmus lasting < 1 min. Brain MRI demonstrated neurovascular contact between the cranial nerve VII/VIII complex and the anterior inferior cerebellar artery....

Clinicians should consider vestibular paroxysmia in patients presenting with positional nystagmus that does not respond to standard BPPV repositioning maneuvers, especially when accompanied by aural fullness or hemifacial spasm.

This case highlights a diagnostically challenging BPPV mimic that, if misidentified, leads to repeated ineffective repositioning maneuvers instead of appropriate pharmacological or surgical management.

1. 01A 69-year-old man presented with positional nystagmus and vertigo clinically resembling BPPV.
2. 02The true diagnosis was vestibular paroxysmia — a condition caused by vascular compression of the vestibular nerve.
3. 03Additional features included left aural fullness and hemifacial spasm, which are atypical for BPPV.
4. 04Differentiating vestibular paroxysmia from BPPV requires careful history-taking and may need MRI.
5. 05Treatment for vestibular paroxysmia (e.g., carbamazepine, microvascular decompression) differs entirely from BPPV canalith repositioning.

PMID

42403435

DOI

10.1002/jgf2.70146.

Journal

Journal of General and Family Medicine

Publication type

case_report

Evidence level

4

Sample size

1

Population

69-year-old male with atypical positional nystagmus

Intervention

Diagnosis and management of vestibular paroxysmia