Late Cerebellar Vermis Metastasis of Breast Cancer Presenting as Pseudo-Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disease; however intracranial lesions can mimic it. Intractable, not self-limiting paroxysmal positional vertigo sustained by intracranial tumors is called malignant paroxysmal positional vertigo (MPPV) while, when radiological imaging shows vascular cerebellar vermis lesions and there are atypical findings on the Dix-Hallpike maneuver, we speak about pseudo-benign paroxysmal type (pseudo-BPPV). We present the case of a 53-years-old woman who presented a pseudo-BPPV as the first sign of a cerebellar vermis late metastasis from a breast cancer treated 13 years before. Lesions of the malignancy located in cerebellar vermis provoked a MPPV, but the nature of the pathology is different from that of pseudo-BPPV, which predominantly has vascular origin. However, there may be forms of pseudo-BPPV caused by malignancies, as in our case. As regard the differentiation between pseudo-BPPV and MPPV, a radiological investigation must be undertaken in every doubtful case.