A Case of Positional Vertigo and Nystagmus Caused by Cerebellar Pathology: The Role of Ocular Motor Testing

Abstract Positional vertigo is a common symptom of vestibular dysfunction that can result from peripheral or central causes. Central positional nystagmus is a rare sign of brainstem or cerebellar pathology. This case is associated with intracerebellar hemorrhage and highlights the role of ocular motor testing in the diagnosis and management. A 71-year-old man with diabetes and hypertension presented with positional vertigo and nausea for 1 month. He had a history of sudden severe vertigo, imbalance, headache, and vomiting 1 month ago. Brain imaging performed one month earlier showed intracerebellar hemorrhage with intraventricular extension due to arteriovenous malformation in the left cerebellum involving the nodulus. During the current presentation after 1 month, he had apogeotropic horizontal nystagmus during positional testing. He also had hypometric saccades, impaired smooth pursuit, square-wave jerks, and head-shaking nystagmus. He was treated with conservative management and vestibular rehabilitation therapy and symptoms improved over 6 weeks. Cerebellar lesions can affect various aspects of eye movements and cause positional vertigo. This case demonstrates the complexity of the vestibulocerebellar interactions and the importance of a comprehensive approach for positional vertigo.