Positional vertigo can be divided into benign paroxysmal positional vertigo and central positional vertigo. In the early stage of patients with central positional vertigo, the imaging of smaller lesions on MRI is not obvious,optokinetic examination and head impu-nystagmus-test of skew are not the gold standards for identifying benign paroxysmal positional vertigo and central positional vertigo. In this paper, one case of 64-year-old female with benign paroxysmal positional vertigo was reported. She was admitted to hospital due to sudden vertigo with nausea and vomiting. History of hypertension and cerebral infarction, results of MRI, optokinetic examination and head impulse examination indicated that the patient might suffer from central positional vertigo. However, normal results of coordination movement and neurological examination, positive result of Dix-Hallpike and roll test couldn’t rule out the possibility of benign paroxysmal positional vertigo. Since vertigo was evident when the patient’s head turned to the right, Epley respositioning procedure was done on her right ear. After therapy, the patient’s symptoms improved, and her benign paroxysmal positional vertigo was diagnosed finally. No recurrence was found after one month follow-up. In order to reduce the occurrence of misdiagnosis, detailed inquiry of medical history, careful physical and assistant examinationand must be implemented in patients with vertigo.

The authors have declared that no competing interests exist.

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