Early Manifestation of Benign Paroxysmal Positional Vertigo: A Case Report.

Introduction: Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder with a heterogeneous etiology, often linked to preceding infections, head injuries, or vestibular neuronitis. While it is commonly observed in the elderly, its occurrence in the pediatric population is rare. To our knowledge, there have been no reported cases of BPPV in patients younger than 5 years. Case Presentation: A 4.5-month-old female infant was admitted with episodes of paroxysmal nystagmus. Parents reported fast horizontal eye movements lasting up to 30 s, with one episode accompanied by vomiting. Comprehensive differential diagnosis was considered from epileptic nystagmus to intoxications and both central and peripheral vestibular etiologies. During the observation on ward, connection between the baby's positioning and nystagmus was identified. The diagnostic roll test confirmed a transient positional geotropic nystagmus. The diagnosis aligned with BPPV characteristics, pointing to the right lateral semicircular canal canalolithiasis. A successful Lempert roll maneuver was performed with prompt effect. To further support the diagnosis and research, we introduced a semiautomatic video-oculography method. Conclusion: This case highlights a rare instance of BPPV in an infant. The clinical findings combined with the effectiveness of the repositioning maneuvers support the diagnosis of right lateral semicircular canal lithiasis. Despite the rarity of this condition in such a young-age group, the need for thorough diagnostic evaluations is emphasized. In order to document the case, we also present a semiautomatic video analysis pipeline for analyzing abnormal eye movements in a home setting.