Vestibular Paroxysmia Presenting With Atypical Positional Nystagmus Resembling Benign Paroxysmal Positional Vertigo

A 69-year-old man presented with recurrent vertigo triggered by positional changes, left aural fullness, and left hemifacial spasm. The supine roll test showed direction-changing apogeotropic horizontal nystagmus lasting < 1 min. Brain MRI demonstrated neurovascular contact between the cranial nerve VII/VIII complex and the anterior inferior cerebellar artery. Carbamazepine 200 mg/day achieved complete symptom resolution within 2 weeks and remission at 6 months. This report describes vestibular paroxysmia presenting with nystagmus resembling that observed in benign paroxysmal positional vertigo and, to our knowledge, represents the first report of direction-changing apogeotropic horizontal nystagmus in this disorder.