Case report discussion
In (Yoosefinejad 2015) they say the patient symptoms were exacerbated by
the Dix-Hallpike maneuver and that lead them to make sure that the
diagnosis was BPPV but we don’t know what they mean by “exacerbation of
symptoms” they didn’t report the duration, direction, latency of the
elicited nystagmus and we can’t trust their judgment as central
positional vertigo is still not excluded from the diagnosis which means
the patient’s vertigo could be of central cause, in this case, MS as the
patient was previously diagnosed by MS six years before the vertigo
onset.
In Must 2020, as in our case, the patient’s vertigo was alleviated by
the use of steroid therapy. Moreover, deep head hanging maneuver was
applied but without any positive result which further suggests the
central cause of vertigo and MS was confirmed by MRI.
The cases reported in this review and our case report suggest that
central positional vertigo associated with MS could be easily
misdiagnosed as BPPV. It may not be that difficult if the case comes
with new-onset positional vertigo after initial diagnosis with MS, but
on the other hand, if the reverse happens as in our case the final
decision of BPPV diagnosis should be carefully taken after ruling out
other possible central causes.
The Provoking maneuvers like Dix-hall pike and Supine head roll test
results are very crucial in making the diagnosis, minute changes or
atypical presentation should raise our susception to central causes, MRI
and CT scans can be good tools to rule out central causes before final
BPPV diagnosis decision is taken in this case. After all, we suggest
more primary research observational retrospective to and clinical trials
should be done to investigate the MS and BPPV association and possible
error in diagnosis.