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Early Manifestation of Benign Paroxysmal Positional Vertigo: A Case Report
Matyas Ebel1, Alena Jahodova1, Jaroslav Jerabek2
1Department of Paediatric Neurology, 2nd Faculty of Medicine, University Hospital in Motol, Charles University, Prague, Czech Republic.
Insights
Benign paroxysmal positional vertigo (BPPV), a rare inner ear condition, was diagnosed in a 4.5-month-old infant. Prompt treatment with a repositioning maneuver resolved the infant's vertigo and nystagmus.
Area of Science:
- Pediatric Neurology
- Vestibular Disorders
- Ophthalmology
Background:
- Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder, typically affecting the elderly.
- BPPV in infants is exceptionally rare, with no prior documented cases in children under five years old.
Observation:
- A 4.5-month-old infant presented with paroxysmal nystagmus and vomiting, prompting a broad differential diagnosis.
- Positional triggers for nystagmus were identified, leading to a diagnosis of right lateral semicircular canal canalolithiasis.
Findings:
- The infant's condition was successfully treated with the Lempert roll maneuver, demonstrating prompt therapeutic effect.
- A semiautomatic video-oculography method was utilized for enhanced diagnosis and documentation of abnormal eye movements.
Implications:
- This case underscores the possibility of BPPV in very young infants, necessitating thorough diagnostic evaluation.
- The successful application of repositioning maneuvers and video-oculography in this case offers valuable insights for managing pediatric vestibular disorders.
Introduction:
Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder with a heterogeneous etiology, often linked to preceding infections, head injuries, or vestibular neuronitis. While it is commonly observed in the elderly, its occurrence in the pediatric population is rare. To our knowledge, there have been no reported cases of BPPV in patients younger than 5 years.
Case Presentation:
A 4.5-month-old female infant was admitted with episodes of paroxysmal nystagmus. Parents reported fast horizontal eye movements lasting up to 30 s, with one episode accompanied by vomiting. Comprehensive differential diagnosis was considered from epileptic nystagmus to intoxications and both central and peripheral vestibular etiologies. During the observation on ward, connection between the baby's positioning and nystagmus was identified. The diagnostic roll test confirmed a transient positional geotropic nystagmus. The diagnosis aligned with BPPV characteristics, pointing to the right lateral semicircular canal canalolithiasis. A successful Lempert roll maneuver was performed with prompt effect. To further support the diagnosis and research, we introduced a semiautomatic video-oculography method.
Conclusion:
This case highlights a rare instance of BPPV in an infant. The clinical findings combined with the effectiveness of the repositioning maneuvers support the diagnosis of right lateral semicircular canal lithiasis. Despite the rarity of this condition in such a young-age group, the need for thorough diagnostic evaluations is emphasized. In order to document the case, we also present a semiautomatic video analysis pipeline for analyzing abnormal eye movements in a home setting.
