A possible link between intracranial lipomas and localization-related relapses in multiple sclerosis.

Intracranial lipomas are congenital malformations representing less than 0.5% of intracranial tumors. They are found incidentally and are asymptomatic in the majority of patients. Here we present three patients with Multiple sclerosis (MS) and intracranial lipomas (IL). The patients showed increased flares and burden of disabling and worsening MS symptoms with cognitive, neurovestibular dysfunction, and gait alterations associated with the localization of the Lipoma. The parenchyma near the Lipomas showed areas of demyelination and atrophy. We postulate that the location and content of the Lipomas may participate in the pathophysiology of MS symptoms in these patients. We conclude that in concurrent IL and MS, the lipomas localization may provoke incapacitating relapses.

Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo.

OBJECTIVE: Describe the diagnosis, treatment, and outcome of a group of 20 patients with lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). STUDY DESIGN AND SETTING: Retrospective review of 20 patients with LSC-BPPV (10 with geotropic and 10 with apogeotropic nystagmus) presenting to a tertiary balance center. Diagnosis was confirmed with infrared nystagmography in Dix-Hallpike positioning tests and supine positional tests. Patients were treated with one or more particle repositioning maneuvers. RESULTS: Addition of supine positional nystagmus tests to Dix-Hallpike positioning testing improves sensitivity in the diagnosis of LSC-BPPV. Treatment outcomes in the apogeotropic LSC-BPPV group were poorer than the geotropic LSC-BPPV group. SIGNIFICANCE: Adding supine positional testing to routine vestibular diagnostic testing will increase the identification of LSC-BPPV. Apogeotropic LSC-BPPV is more challenging to treat.