Probable vestibular paroxysmia mimicking benign paroxysmal positional vertigo of the superior semicircular canal in the presence of a neurovascular conflict: a case report and review of the literature.
Quentin Legois, Laurent Tremelet, Pauline Nieto et al.
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Case in brief
A 52-year-old woman presented with positional vertigo and was initially diagnosed with right superior semicircular canal benign paroxysmal positional vertigo (BPPV). Symptoms persisted despite multiple repositioning maneuvers. Right Dix–Hallpike testing showed positional downbeat and right torsional nystagmus, prompting reconsideration of the diagnosis. On MRI re-evaluation, a neurovascular conflict was identified between the right anterior inferior cerebellar artery and the right vestibulocochlear nerve, supporting probable vestibular paroxysmia mimicking superior canal BPPV.
What made this case unusual
The presentation mimicked superior canal BPPV, but atypical positional nystagmus, failure to respond to repositioning maneuvers, and MRI evidence of neurovascular conflict supported probable vestibular paroxysmia.
Diagnostic / clinical pearl
When positional vertigo is atypical or persists despite repositioning maneuvers, reconsider BPPV; suspected superior canal BPPV warrants particular diagnostic caution and comprehensive assessment.