Cerebellar tuberculous granuloma mimicking benign paroxysmal positional vertigo: progression after initial misdiagnosis
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Authors and affiliations
Kitae Kim1
Hyo-Jung Kim2
Jeong-Yoon Choi13
Zhong Liqun4
Xu Yang5
Ji-Soo Kim13
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1.Department of Neurology, Dizziness Center, Clinical Neuroscience CenterSeoul National University Bundang HospitalSeongnamSouth Korea
2.Research Administration TeamSeoul National University Bundang HospitalSeongnamSouth Korea
3.Department of NeurologySeoul National University College of Medicine, Seoul National University Bundang HospitalKoreaSouth Korea
4.Department of NeurologyDongzhimen Hospital Affiliated to Beijing University of Chinese MedicineBeijingPeople’s Republic of China
5.Department of NeurologyAerospace Center Hospital, Peking University Aerospace School of Clinical MedicinePekingPeople’s Republic of China
Letter to the Editors
First Online: 18 July 2019
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Dear Sirs,

Positional vertigo and nystagmus may occur in association with central as well as peripheral vestibular lesions. Differentiation of central from benign paroxysmal positional vertigo (BPPV) is important due to its potentially grave underlying pathology in central positional nystagmus (CPN) [1, 2]. Herein, we report a patient with apogeotropic CPN due to tuberculous granuloma involving the cerebellar nodulus who had been misdiagnosed as having BPPV initially even with brain MRIs twice and showed a progression into severe imbalance over the following years. This report emphasizes the importance of scrutinized evaluation of the brain using gadolinium-enhanced MRIs in patients with a suspicion of CPN.

A 72-year-old man had worsening vertigo and unsteadiness for about 2 years. Initially, the patient was diagnosed as apogeotropic horizontal canal BPPV (HC-BPPV) based on the observed positional nystagmus. Since the positional nystagmus did not respond to repeated...
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Notes
Author contributions
KK analyzed and interpreted the data and wrote the manuscript. HJK, J-YC, ZL, and XY analyzed and interpreted the data, and revised the manuscript. JSK designed and conceptualized the study, interpreted the data, and revised the manuscript.

Funding
This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (no. NRF-2016R1D1A1B04935568).

Compliance with ethical standards
Conflicts of interest
Drs. K. Kim, H.J. Kim, Choi, Liqun, and Yang reports no disclosures relevant to the manuscript. Dr. J.S. Kim serves as an associate editor of Frontiers in Neuro-otology and on the editorial boards of Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, Journal of Vestibular Research, Journal of Neurology, and Medicine.

Ethical standard
This study followed the tenets of the Declaration of Helsinki, and was performed according to the guidelines of Institutional Review Board of Seoul National University Bundang Hospital (B-1907–552-702).

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© Springer-Verlag GmbH Germany, part of Springer Nature 2019
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Cite this article as:
Kim, K., Kim, HJ., Choi, JY. et al. J Neurol (2019) 266: 2581. https://doi.org/10.1007/s00415-019-09478-8
Received
12 July 2019
 Accepted
15 July 2019
 First Online
18 July 2019
 DOI
https://doi.org/10.1007/s00415-019-09478-8
 Publisher Name
Springer Berlin Heidelberg
 Print ISSN
0340-5354
 Online ISSN
1432-1459
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