Vestibular symptoms of vestibular schwannoma (VS) can be diverse, though positional vertigo is relatively unusual in VS. We experienced a case with VS presenting positional vertigo mimicking BPPV. A failure of repeated particle repositioning maneuver and observation of atypical nystagmus during follow-up prompted authors to examine the brain through magnetic resonance imaging (MRI). Brain MRI revealed 3.5 mm sized right intracanalicular VS. Diagnostic test showed grossly normal except abolished vestibular evoked myogenic potential response of right side. The patient had been followed-up over 3 years with tests repeated annually. In conclusion, VS may present positional vertigo with positional nystagmus. Ephaptic transmission which may be initiated and changed by head position or partial loss of vestibular tone from inferior vestibular nerve can be suggested as possible mechanisms. Radiologic evaluation should be considered for those patients who showed intractable positional vertigo or atypical positional nystagmus.
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