The role of high-resolution magnetic resonance in atypical and intractable benign paroxysmal positional vertigo: Our preliminary experience

Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) is easy when typical nystagmus is present. However, diagnostic doubts arise when faced with cases presenting atypical features of the positional paroxysmal nystagmus as well as the clinical course and disease evolution. Methods: A morphological evaluation of inner ear structures via high-resolution magnetic resonance (HR-MR) studies has been performed in 2 patients that did not respond to traditional therapeutic manoeuvres. Results: In 1 patient, a filling defect at the level of the middle portion of the right lateral semicircular canal (LSC) has been demonstrated, while in the second one, a geometric-architectural abnormality - a 'fold' in the LSC - has been observed. Conclusion: HR-MR study of the inner ear offers a meaningful contribution to interpreting the physiopathogenesis of atypical cases of BPPV. HR-MR of the inner ear is a safe and useful tool to investigate patients with atypical and intractable BPPV.