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Central positional nystagmus: an update.

João Lemos1, Michael Strupp2

  • 1Department of Neurology. Coimbra University and Hospital Centre, Portugal and Faculty of Medicine, Coimbra University, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal. merrin72@hotmail.com.

Journal of Neurology
|October 20, 2021
PubMed
Summary
This summary is machine-generated.

Central positional nystagmus (CPN) is a condition caused by brainstem or cerebellar issues, often mimicking peripheral vertigo. Early diagnosis and understanding its varied causes are crucial for effective management.

Keywords:
Benign paroxysmal positional vertigoCentral positional nystagmusPositional downbeat nystagmusPositional vertigo

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Area of Science:

  • Neurology
  • Ophthalmology
  • Vestibular System Science

Background:

  • Central positional nystagmus (CPN) is often suspected in patients with atypical benign paroxysmal positional vertigo (BPPV).
  • CPN arises from dysfunction in the cerebellum and/or brainstem, distinct from peripheral vestibular disorders.
  • Understanding CPN's diverse clinical presentations and underlying pathophysiology is essential for accurate diagnosis.

Purpose of the Study:

  • To review and synthesize current findings on Central Positional Nystagmus (CPN) from recent literature.
  • To elucidate the clinical phenotypes, underlying pathomechanisms, and diagnostic challenges of CPN.
  • To highlight CPN as a critical differential diagnosis for BPPV.

Main Methods:

  • A PubMed literature review was conducted using keywords related to Central Positional Nystagmus and Central Positional Vertigo.
  • The search focused on studies published between January 2015 and August 2021.
  • Analysis included clinical data, associated lesions, nystagmus characteristics, and diagnostic indicators.

Main Results:

  • CPN accounts for up to 12% of positional nystagmus cases, often linked to structural lesions (stroke, tumors, demyelination) or diffuse diseases affecting the cerebellum/brainstem.
  • Clinical presentations vary, including paroxysmal or persistent nystagmus, often downward or apogeotropic, and are frequently accompanied by other central neurological signs.
  • CPN is typically unresponsive to BPPV maneuvers and requires identification of underlying causes or symptomatic treatment.

Conclusions:

  • CPN represents a significant differential diagnosis for BPPV, characterized by heterogeneous presentations and etiologies.
  • Accurate diagnosis relies on recognizing associated neurological signs and differentiating from peripheral causes.
  • Further research into the natural course and treatment strategies for CPN is warranted.