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.