A Rare Case of Posttraumatic Bilateral BPPV Presentation

Abstract

A rare case of a 38-year-old female patient who developed benign paroxysmal positional vertigo (BPPV) three weeks after head trauma is presented. The disease manifested bilaterally, which is not uncommon posttraumatically, but in this case, it manifested itself as canalithiasis of the posterior canal on both sides and cupulolithiasis of the right lateral canal, which to our knowledge is a unique and, until now, unpublished case. The aim of this review is to point out the fact that, in such a complex multicanal and bilateral clinical presentation of BPPV, it is not sufficient to perform only positioning but also additional laboratory tests. With a good knowledge of the etiopathogenesis, pathophysiology and clinical forms of BPPV, we can, in most cases, make an accurate and precise diagnosis of the disease and carry out appropriate treatment.

Figure 1

Left-sided Dix–Hallpike test performed during the initial videonystagmography (VNG) recorded upbeat nystagmus, of SPV 22°/s.

Figure 2

Right-sided Dix–Hallpike test performed during the initial VNG recorded horizontal ageotropic nystagmus of SPV 13°/s.

Figure 3

Right-sided Dix–Hallpike test performed during the follow-up exam a week after the initial VNG recorded geotropic vertical-rotatory PN lasting for 10 seconds with the upbeat directed vertical component of SPV 31°/sec and a torsion geotropic directed component of SPV 8°/sec.