수평반고리관 Cupulolithiasis에 의한 양성 돌발성 체위변환성 어지러움증으로 오인된 소뇌경색 1예

Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. It can be diagnosed with characteristic symptoms and the nystagmus evoked by the positional change. We report a case of cerebellar infarction misdiagnosed as BPPV. A 58 years-old man, complaining rotatory positional vertigo for 3 days, visited our OPD. A head positional test was performed. and it induced positional ageotrophic nystagmus. He showed no neurologic abnormality in neurologic examination. We diagnosed his illness as cupulolithiasis of horizontal canal, so the cupulolith repositioning maneuver, applying vibrator on mastoid tip and forced prolonged position maneuver were performed. Then, the vertigo and the intensity of nystagmus were improved. Four days later, however, vertigo was aggrevated again showing same nystagmus. So we recommended magnetic resonance imaging, and multiple cerebellar infarctions were found. Even if patient shows typical nystagmus of BPPV, the neuroradiologic study should be conducted to rule out central lesion, in the case of no response to repositioning maneuver or reaggrevation. (J Clinical Otolaryngol 2004;15:311-315)