Introduction
Multiple sclerosis (MS) is one of the most common and best-known demyelinating disease with peak incidence between 20 and 30 years of age (1). MS has a wide range of presentation and equal wide range of prognosis. Classically, MS is diagnosed by finding multiple white matter lesion separated by space and time while, the clinical features are defined by the location of lesion. Common clinical features include corticospinal tract signs (weakness and spasticity), sensory abnormalities, and cerebellar dysfunction (intention tremors and ataxia) (2). In patients with MS, equilibrium disorders caused by involvement of brainstem and cerebellar structures are common and about 20% of MS patients representing by true vertigo at some time during the disease. However, peripheral conditions such as benign paroxysmal positional vertigo (BPPV) and central positional vertigo were also reported (3). Therefore, an accurate otoneurologic investigation paying attention to differentiate between central and peripheral cause. Central positional vertigo associated with MS could be easily misdiagnosed as BPPV. It could be difficult if it occurred as the initial MS symptoms to differentiate it from BPPV. The Provoking maneuvers like Dix-hall pike and Supine head roll test results are very crucial in making the diagnosis (4).
In this article we represented a case of central positional vertigo as an initial multiple sclerosis symptoms accompanied with systematic review of previous related cases.