Case report: Atypical benign paroxysmal postural vertigo

Abstract

Benign paroxysmal postural vertigo (BPPV) is characterized by brief episodes of vertigo triggered by changes in head position, accompanied by characteristic nystagmus, which allows identification of the affected semicircular canal. The idiopathic form is the most frequent (50%); among the secondary causes, the most frequent is the posttraumatic. Anterior canal BPPV is the least common atypical variant, accounting for about 1-2 percent of cases and horizontal semicircular canal BPPV may be responsible for 10–20% of cases of BPPV. We present a 76-year-old man with a history of head trauma who consults for recurrent episodes of dizziness, triggered by sudden movements of the head and changes in body position, accompanied by loss of balance while walking. Clinical and instrumental otoneurological evaluation was performed. Bilateral ageotropic horizontal nystagmus was detected with the Mc-Clure test diagnostic maneuver. Canalicular repositioning maneuvers were performed; after the maneuver the atypical positional nystagmus disappeared. After seven months of follow-up, recurrence of nystagmus was detected; bilateral Dix-Hallpike test provoked down beating nystagmus with a torsional component. Yacovino maneuver was performed with resolution of the symptoms.