Monthly Archives: November 2015

Positional Down Beat Nystagmus: Central or Peripheral

Patient 52yr waked up with positional vertigo: when he turned in bed, he felt strong short vertigo. On the next day he leaned forward (fixing washing machine) and then he felt strong vertigo, instability, nausea and vomiting. After that restrictive movements and sleeping on big pillows.

Very standard history for BPPV, isn’t it?

Dix-Hallpike test: Down Beating Nystagmus with very discreate cw torsion component but without vertigo! He felt vertigo when returning to the sitting position.

Deep head hanging maneuver didn’t work. Than Epley from the right side. After that control DH test ok.

Five days later he was still dizzy but positional testing: from standing with head bent to the left, when he quickly raise head to the upright position, he felt short spin and I saw two downbeating Ny.
Calorics, VHIT, SVV, oVEMP and oto-neurological exam normal.

I send him to perform MRI as I do evry time when I see down-beating Ny

MRI demonstrated two lesions at cerebellar peduncles bilaterally
MRI cerebellar peduncle lesion

On that occasion (15 days later) Dix-Hallpike was possitive to the right. Usual upbeating and torsional ccw Ny.

After one Epley meneuver he is without any vestibular complaints.