Vertige positionnel paroxystique découvrant un kyste épidermoïde du quatrième ventricule

Objective

To report a case of atypical positional vertigo revealing a fourth ventricle epidermoid cyst.

Material and methods

We report a case of a thirty-year-old woman suffering from positional vertigo with downbeat nystagmus. Except for these symptoms, the physical examination was normal, apart from intermittent headaches. On videonystagmography, a decrease in the average speed of beats and lowered benefits obtained by slow motion were noted. MRI revealed a fourth ventricle epidermoid cyst.

Results

Physical examination may provide several signs that are likely to enable the examiner to distinguish between central nervous system or peripheral vertigos. Atypical symptoms such as a downbeat nystagmus, a lack of reversal in nystagmus beats when returning to the sitting position and a lack of a latency period in vertigo and nystagmus occurrence during the Dix-Hallpike maneuver suggest a central nervous system etiology.

Conclusion

With atypical symptoms noted when questioning the patient or during physical examination, a central nervous system etiology should be mentioned and explored with cerebral MRI.