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Central cause of positioning vertigo
  1. Jonathan Paul Donnelly1,
  2. Andrew Martin Chancellor1,
  3. Adam El-Dieb1,2
  1. 1 Department of Neurology, Tauranga Hospital, Tauranga, New Zealand
  2. 2 Department of Radiology, Tauranga Hospital, Tauranga, New Zealand
  1. Correspondence to Dr Jonathan Paul Donnelly, Department of Neurology, Tauranga Hospital, Tauranga 3112, New Zealand; docjsilver{at}gmail.com

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A previously well 46-year-old male doctor presented with a 10-week history of distressing vertiginousness with nausea, induced by rapid head movement, persisting for a few seconds, suggesting benign paroxysmal positional vertigo (BPPV). However, he could not reliably induce vertigo with any particular head positioning.

Repeated treatments for BPPV with a physiotherapist over 3 weeks did not help. The patient thereafter sought neurological input, when he noticed mild but progressive lack of dexterity using the left, non-dominant hand. His positioning symptoms did not deteriorate further.

On examination, there was mild ocular dysmetria but no primary position or gaze-evoked …

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