Pseudo-Benign Paroxysmal Positional Vertigo: A Retrospective Study and Case Report

Abstract

Pseudo-benign paroxysmal positional vertigo (pseudo-BPPV) is a specific type of vestibular migraine disguised as benign paroxysmal positional vertigo, which is characterized by recurrent different types of positional and atypical positional vertigo with migraine features. It is easy to be misdiagnosed with BPPV at the first visit, which means that the ideal therapeutic effects are not achieved. Twenty-five cases of pseudo-BPPV with frequent changing positional vertigo were retrospected and the following key features help to identify the disease: recurrent positional and atypical positional vertigo, migrainous accompanying symptoms or migraine history, mild or indistinctive headaches, with or without impaired vestibular function, ineffective for simply reposition. And we found that vertigo in pseudo-BPPV can be preferable controlled by valproic acid combined with canalith repositioning procedure.

Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers

“…Up to 20% of cases of positional vertigo may be due to central pathology (29), caused by disease affecting the central nervous system, such as multiple sclerosis, cerebellar disease, and cerebellar stroke, with vestibular migraine being the most common central cause (30). Suspicion of central positional vertigo may be raised with an absence of latency or fatigability of nystagmus, a lack of marked vertigo, pure upbeat or downbeat nystagmus, or as a lack of responsiveness to CRM (31).…”

“…There is increasing evidence about the association between vestibular migraine (VM) and BPPV (29). Despite their similarities, BPPV can be differentiated from VM by the direction of the nystagmus and the duration of the symptoms (32, 33).…”

“…Despite their similarities, BPPV can be differentiated from VM by the direction of the nystagmus and the duration of the symptoms (32, 33). Although there is generally no positional nystagmus in VM, pseudo-BPPV is a complex mix of positional, atypical positional and non-positional vertigo accompanied by migraine features; the ability to distinguish pseudo-BPPV from other vertigo disease has great clinical significance for treatment (29).…”

Managing patients with positional vertigo: diagnostic pitfalls and treatment

“…При этом в эпидемиологических исследованиях в качестве самых частых причин позиционного головокружения указываются такие диагнозы, как ДППГ и вестибулярная мигрень, возможно и сочетание этих заболеваний у одного пациента [16,17]. Ряд авторов также указывают на возможную дисфункцию отолитового аппарата, которая развивается в рамках вестибулярной мигрени и приводит к кратковременным приступам позиционного головокружения [18].…”

Vestibular migraine: epidemiology, pathogenesis, clinical picture, diagnosis and treatment

“…В группе из 25 пациентов J. Yu и соавт. (2020) показана эффективность вальпроевой кислоты в сочетании с репозиционными маневрами [48]. Таким образом, ВМ должна быть заподозрена при наличии у пациента атипичного позиционного нистагма / головокружения, к числу основных характеристик которого относятся: выявление других неврологических симптомов, наличие изолированного меняющего направление позиционного нистагма, отсутствие латентного периода, низкая скорость, большая продолжительность и отсутствие ответа на репозиционные маневры [49].…”