Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal.
Faculty of Medicine, Coimbra University, Coimbra, Portugal.
Pract Neurol. 2024 Jan 23;24(1):51-55. doi: 10.1136/pn-2023-003884.
Positional vertigo poses a diagnostic challenge in people with multiple sclerosis (MS). The characteristics of positional nystagmus and its response to repositioning manoeuvres are usually sufficient to diagnose benign paroxysmal positional vertigo (BPPV). However, certain BPPV variants respond poorly to repositioning manoeuvres and their nystagmus pattern can resemble that of central positional vertigo caused by infratentorial demyelination. This diagnostic difficulty is particularly challenging if positional vertigo occurs during an MS relapse. We describe a woman with MS who developed a sixth nerve palsy and gaze-evoked nystagmus, caused by demyelination near or within areas classically involved in central positional vertigo. However, she also had positional vertigo from coincident BPPV (and not central positional vertigo). This was initially a treatment resistant-posterior semicircular canal cupulolithiasis but it later progressed to a posterior semicircular canal canalolithiasis, with symptoms promptly resolving after a repositioning manoeuvre.
位置性眩晕给多发性硬化症（MS）患者的诊断带来了挑战。位置性眼球震颤的特征及其对变位动作的反应通常足以诊断良性阵发性位置性眩晕（BPPV）。然而，某些 BPPV 变体对变位动作反应不佳，其眼球震颤模式可能类似于由桥脑下脱髓鞘引起的中枢性位置性眩晕。如果 MS 复发期间出现位置性眩晕，则这种诊断困难更加具有挑战性。我们描述了一位 MS 患者，她因桥脑下与中枢性位置性眩晕相关区域附近或内部的脱髓鞘而出现第六神经麻痹和眼震诱发的眼球震颤。然而，她也同时存在由巧合性 BPPV 引起的位置性眩晕（而非中枢性位置性眩晕）。最初，她患有难治性后半规管壶腹嵴结石症，但后来进展为后半规管管结石症，变位动作后症状迅速缓解。
