Balance Disorders and Ataxia Service, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia (L.P., D.J.S.); Florey Institute of Neuroscience and Mental Health, Melbourne, Australia (L.P., D.J.S.); Dizzy Day Clinics, Melbourne, Australia (L.P., K.M.); Department of Neurosurgery (K.B.) and Medical Imaging Department (N.T.), St Vincents Hospital, Melbourne, Australia; Department of Neurosurgery, Royal Melbourne Hospital, and Department of Surgery, University of Melbourne, Australia (K.J.D.); and Neuroscience Department, Cerebellar Ataxia Clinic, Alfred Health, Melbourne, Australia (D.J.S.).
J Neurol Phys Ther. 2019 Jul;43(3):186-191. doi: 10.1097/NPT.0000000000000276.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. The term "benign" is consistent with a peripheral vestibular disorder that does not carry the potentially sinister sequelae of a central nervous system (CNS) cause. However, in 12% to 20% of cases, positional vertigo may be attributed to CNS pathology, including tumors of the cerebellum.
Here, we present a series of 3 cases in which positional vertigo and nystagmus were the only presenting features in 2 cases of cerebellar tumor and 1 case of obstructive hydrocephalus.
All patients underwent surgical intervention for removal of posterior fossa tumors or posterior fossa decompression for obstructive hydrocephalus. Following surgery, all 3 patients underwent a period of vestibular rehabilitation for postoperative motion sensitivity and balance impairment.
Despite the continuing presence of central positioning nystagmus, all 3 patients recovered well, putatively with the aid of vestibular rehabilitation.
The presence of central positioning nystagmus may be the sole presenting feature of serious neurological conditions such as posterior fossa tumor. It is recommended that a diagnosis of BPPV can only be made if Dix-Hallpike or supine roll maneuver elicits nystagmus that is consistent with BPPV. Any features of the nystagmus, which are not consistent with BPPV, should raise suspicion of central pathology, and warrant further investigation.Video Abstract available for more insights from the authors (see Video Abstract, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A265).
良性阵发性位置性眩晕（BPPV）是位置性眩晕最常见的原因。“良性”一词与外周前庭障碍一致，后者不会带来中枢神经系统（CNS）病因的潜在险恶后果。然而，在 12%至 20%的病例中，位置性眩晕可能归因于 CNS 病理学，包括小脑肿瘤。
在这里，我们介绍了 3 例病例，其中 2 例小脑肿瘤和 1 例阻塞性脑积水仅表现为位置性眩晕和眼球震颤。
所有患者均接受了手术干预，以切除后颅窝肿瘤或后颅窝减压以治疗阻塞性脑积水。手术后，所有 3 例患者均接受了一段时间的前庭康复治疗，以治疗术后运动敏感性和平衡障碍。
尽管存在中枢性位置性眼球震颤，但所有 3 例患者均恢复良好，推测是在前庭康复的帮助下。
中枢性位置性眼球震颤可能是严重神经疾病（如后颅窝肿瘤）的唯一表现特征。建议只有在 Dix-Hallpike 或仰卧位翻滚试验引发与 BPPV 一致的眼球震颤时，才能做出 BPPV 的诊断。任何与 BPPV 不一致的眼球震颤特征都应怀疑中枢性病变，并需要进一步调查。视频摘要可提供更多作者见解（请参见视频摘要，补充数字内容 1，可在以下网址获取：http://links.lww.com/JNPT/A265）。
