Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo Co-existing with Cranial Nerves Schwannoma and Meniere Disease: Case Report

Benign Paroxysmal Positional Vertigo (BPPV) is characterized by intense positional provoked vertigo with a brief duration and is one of the most common types of peripheral vestibular problems. The most commonly affected semi-circular canal is the posterior canal with a greater prevalence seen in females between the ages of 71-80. BPPV has a 60% right ear predisposition with canalithiasis as the predominant type. Most cases are unilateral, although bilateral BPPV is not atypical when associated with falls with head trauma, ototoxicity or co-existing vestibulopathy. To our knowledge, reports on bilateral BPPV coexisting with bilateral progressive vestibulopathy are scant. We describe a case of bilateral posterior canal BPPV with definite Menieres Disease (MD), Vestibular Schwannoma (VS) secondary to a schwannoma arising from the Jugular Foramen (JF) with mass effect and an incidental schwannoma of the right orbital optic nerve. Underlying BPPV may mask other clinical presentations, making it challenging to diagnose co-existing vesitbulopathy, especially those of a progressive episodic nature. In making management decisions, this serves as a reminder for clinicians to have in-depth conceptual and procedural knowledge to recognise and focus on the insidious progressive pathologies and not be distracted by the easily treatable BPPV.