[Cerebellar hemangioblastoma presenting with positional vertigo as the initial symptom: a case report and literature...

The clinical data and diagnostic process of a cerebellar hemangioblastoma (HB) patient presenting with positional vertigo and nystagmus as initial symptomwere retrospectively analyzed. To identify studies involving patients with positional vertigo secondary to cerebellar tumors misdiagnosed as benign paroxysmal positional vertigo (BPPV), a comprehensive literature search was systematically performed in databases such as PubMed, Wanfang, CNKI, and etc., covering the period from January 2004 to December 2024. The patient presented with positional vertigo as the primary symptom.An initial diagnosis of anterior semicircular canal BPPV was made, but attempts at canalith repositioning therapy proved ineffective. Furtherbrain MRI revealed a cystic mass in the right cerebellum. Histopathological examination of the resected specimen confirmed HB. Twenty-eight patients were included in the literature review, nine of whom were ultimately diagnosed with HB, and lesions predominantly involved midline cerebellar structures, including the nodulus and uvula. Literature analysis revealed that misdiagnosis was most often attributable to isolated positional vertigo, in the absence of specific central nervous system symptoms. And the key differential diagnostic features distinguishing CPPV from BPPV and other disorders included the therapeutic efficacy of canalith repositioning maneuvers and characteristics of positional nystagmus. Clinicians should synthesizea comprehensive evaluation, incorporating medical history, physical examination, auditory-vestibular function tests, and neuroimaging, to identify differential diagnostic features andthereby establish an accurate diagnosis.