Abstract
This case study describes transient downbeat nystagmus with vertigo due to a bilateral Bow Hunters Syndrome that was initially treated for 7 months as a peripheral benign paroxysmal positional vertigo. Normal static angiography and imaging studies (magnetic resonance, computed tomography) contributed to the mis-diagnosis. However, not until positional testing with the patient in upright (non-gravity dependent) was a transient downbeat nystagmus revealed with vertigo. The patient was referred for neurosurgical consult. Unfortunately, surgery was delayed due to suicidal ideation and hospitalization. Eventually, vertigo symptoms resolved following a C4-5 anterior cervical dissection and fusion. This case highlights the critical inclusion of non-gravity dependent position testing as an augment to the positional testing component of the clinical examination as well as the extreme duress that prolonged positional vertigo can cause.
Original language | English (US) |
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Article number | 814998 |
Journal | Frontiers in Neurology |
Volume | 12 |
DOIs | |
State | Published - Dec 20 2021 |
Keywords
- Bow Hunter's syndrome
- downbeat nystagmus
- neurological examination
- positional nystagmus
- positional vertigo
ASJC Scopus subject areas
- Neurology
- Clinical Neurology