Table 1

Characteristics of the included reports1–17 28–38

	Author	Age and sex	Number of episodes and duration of RVM	Associated symptoms	Associated examination findings	Investigations and imaging	Likely underlying aetiology	Location	Management
1	Hornsten,29 case 6	Not specified	One episode, few minutes.	Headache, blurred vision, vertigo, imbalance.	Vertical diplopia, monocular vision blurriness, ipsilateral facial weakness, crossed and dissociative sensory loss, pain and temperature.	CT/MRI not completed.	Lateral medullary stroke.	PICA, but not specified.	Not specified.
2	Hornsten,29 case 13	Not specified	One episode, few minutes.	Transient episodes of vertigo prior to the event (weeks to 6 months), vertigo, imbalance.	Vertical diplopia, head tilt exacerbated diplopia, ipsilateral falling tendency, limb ataxia, sensory loss.	CT/MRI not completed.	Lateral medullary stroke.	PICA, but not specified.	Not specified.
3	Ropper,3 case 3	71F	One episode, 5 min.	Vomiting, dizziness.	Horizontal left-beating nystagmus.	CT: enhancing lesion in L cerebellar hemisphere. CT angiogram: normal. ECG: atrial fibrillation.	Cardioembolic ischaemic stroke.	L cerebellar hemisphere.	Conservative, full resolution.
4	Solms et al12	12M	Multiple episodes, <4 min.	7 weeks after abscess surgery, RVM with nausea, unsteadiness.	Normal examination.	CT: patches of gliosis in the location of previous abscesses, left basal frontal and right mediobasal frontal.	Frontal abscess.	Frontal L and R.	Conservative, full resolution at 20-week follow-up.
5	Pamir et al30	Not specified	Not specified.	Not specified.	Not specified.	Not specified.	Third ventriculostomy.	Third ventricle.	Unclear.
6	Charles et al31	48F	One episode, 30 min.	Vertigo, nausea and vomiting 24 hours post motor vehicle accident.	R deviation during walk, bilateral horizontal jerk nystagmus, hypoesthesia of L thumb. L biceps and brachioradialis reflexes were diminished.	MRI: floccular nodular lesion of L cerebellum. Angiogram: L vertebral artery dissection.	Vertebral artery dissection, posterior ischaemia.	Flocculus and nodulus cerebellum.	500 mg aspirin daily.
7	Stracciari et al,15 case 1	69F	Three episodes, 20 min.	Malaise, sweating, nausea, vomiting, R occipital headache.	Normal examination.	MRI/CT: R cerebellar lesion in the territory of the medial branch of PICA.	Cerebellar infarct.	R cerebellar medial PICA.	Ticlopidine 250 mg daily, no further attacks at 2-year follow-up.
8	Stracciari et al,15 case 2	52F	Multiple episodes, <40 min.	Sweating, nausea, occipital headache, dizziness, syncope, vertigo.	L-beating horizontal nystagmus. R and L brachial arterial pressure (R>L by 20 mm Hg).	US carotids: subclavian artery stenosis. CT/MRI brain: normal.	Vertebrobasilar failure from subclavian steal syndrome.	Vertebrobasilar, likely posterior.	Flunarizine 10 mg daily, no further attacks at 6-month follow-up.
9	López et al32	57M	One episode, 30 min.	Intense coughing, headache, vertigo, vomiting, gait ataxia.	L-beating nystagmus, L facial nerve paresis, dysmetria in L upper limb and a broad-based ataxic gait.	CT brain: hypodense area in the L cerebellar hemisphere. Angiography: tortuous basilar artery and stenosis at the origin of the L AICA with a decrease in its distal circulation.	L cerebellar stroke from AICA stenosis.	L cerebellar hemisphere.	Not specified.
10	Doğulu and Kansu7	33F	Multiple episodes, ‘few’ seconds.	Dizziness, facial spasms, inability to look to L side, diplopia. Diagnosed with multiple sclerosis 4 years prior.	L conjugate gaze palsy, slow adduction on R gaze, L peripheral facial myokymia, sensorineural-type hearing deficit.	MRI T2W: high-intensity lesion in pons ventral to the fourth ventricle & multiple periventricular lesions.	MS lesions.	Pons, ventral to the fourth ventricle and periventricular lesions.	Increasing episodes of RVM. She refused hospitalisation. She died 7 years later in 1994.
11	River et al,1 case 2	70M	One episode, 30 min.	Episodes of vertigo, nausea, vomiting, gait instability.	L cerebellar syndrome, L horizontal nystagmus, transient absence of R optokinetic nystagmus.	CT brain: bilateral occipital stroke occupying Brodmann area 18.	Bilateral occipital stroke.	Brodmann area 18.	Unclear.
12	River et al,1 case 3	79M	One episode, 10 min.	Acute vertigo, nausea, vomiting, body levitation.	Gaze apraxia, optical ataxia without simultanagnosia.	Not specified.	Vertebrobasilar stroke and TIA.	Parietal lobes.	Unclear.
13	River et al,1 case 5	54M	Three episodes, 5–10 min.	Seizures, nausea, vomiting, deviation of eyes and head to L, tonic convulsions of L hand.	L hemihypoesthesia, L hemiparesis, hypometric saccade to L, disturbed eye pursuit movements to R, disturbed L optokinetic nystagmus, transient L hemianopia.	CT brain: R parietal enhancement.	Seizures.	R parietal lobe.	Continuous intravenous diazepam, seizures ceased within 48 hours.
14	River et al,1 case 6	75M	Two episodes, 30 min.	Nausea, vomiting.	Normal examination.	CT brain: L temporo-occipital linear skull fracture without parenchymal brain injury.	Trauma, concussion and skull fracture.	L temporo-occipital lobe.	Unclear.
15	Kommerell8	60F	One episode, hours.	Vertigo and RVM post removal of acoustic neuroma.	Ocular tilt reaction with skew and nystagmus.	Not specified.	Surgical removal of acoustic neuroma.	Vestibular nerve.	Conservative, resolved after a few hours.
16	Nisipeanu et al33	18M	Multiple episodes over 1 year, <5 min.	RVM followed by throbbing headache.	Normal examination.	MRI brain: normal.	Migraine.	Unclear.	Unclear.
17	Arjona and Fernández-Romero,28 case 1	Not specified	Not specified.	Not specified.	Not specified.	Not specified.	Herpes zoster infection of VIII nerve neuritis.	Vestibular nerve.	Unclear.
18	Arjona and Fernández-Romero,28 case 2	Not specified	Not specified.	Not specified.	Not specified.	Not specified what kind of imaging. Author states cerebellar haemorrhage.	Haemorrhage.	Cerebellar.	Unclear.
19	Gondim et al13	76M	Multiple episodes, <1 hour.	One episode of syncope. No symptoms apart from episodes of RVM.	Normal examination findings.	EEG: no abnormal activity during RVM episodes. MRI brain: old pontine stroke, no acute ischaemia.	Unclear, possibly seizure.	Unclear.	Initially intravenous heparin. Episodes ceased with initiation of gabapentin.
20	Malis and Guyot,6 case 1	29M	One episode, 2–3 min.	Drop attack, vertigo.	Normal examination.	MRI brain: normal.	Ménière’s disease.	R vestibular nerve.	Unclear.
21	Malis and Guyot,6 case 2	33M	One episode, ‘brief’ seconds.	Vertigo.	Normal examination.	MRI brain: normal.	Ménière’s disease.	R vestibular nerve.	Unclear.
22	Malis and Guyot,6 case 3	85F	Three episodes over 1 year, ‘brief’ seconds.	RVM episode followed by drop attack and then 1–2 hours of typical rotatory vertigo.	Normal examination.	MRI brain: normal.	Ménière’s disease.	R vestibular nerve.	Unclear.
23	Malis and Guyot,6 case 4	81F	Several episodes, minutes.	Unsteady, difficulty standing, vertigo.	Normal examination.	MRI not performed.	Ménière’s disease.	L vestibular nerve.	Unclear.
24	Malis and Guyot,6 case 5	45M	One episode, ‘brief’ seconds.	Vertigo.	Normal examination.	MRI brain: normal.	Ménière’s disease.	L vestibular nerve.	Unclear.
25	Malis and Guyot,6 case 14	58F	Multiple episodes, seconds.	Positional vertigo.	Positional nystagmus.	MRI brain: normal.	Cupulolithiasis.	L vestibular nerve.	Unclear.
26	Malis and Guyot,6 case 17	47F	Multiple episodes, seconds.	Rapid-onset hearing loss, gets episodes of RVM when ear is suctioned.	L-beating nystagmus.	Surgical exploration: perilymphatic fistula of lateral semicircular canal. Previous mastoidectomy for removal of cholesteatoma. MRI not performed.	Perilymphatic fistula of lateral semicircular canal.	L semicircular canal.	Unclear.
27	Malis and Guyot,6 case 18	10M	Multiple episodes, <10 min.	RVM followed by severe headaches.	Normal examination.	MRI brain: normal.	Migraine.	Unclear.	Unclear.
28	Malis and Guyot,6 case 20	33M	One episode, 10 s.	Dizziness while driving.	Normal examination.	MRI brain: normal.	Unclear.	Unclear.	Unclear.
29	Malis and Guyot,6 case 21	39M	One episode, 1 min.	RVM solely, 1 hour post fall on stairs.	Normal examination.	MRI brain: normal.	Unclear? Fall.	Unclear.	Unclear.
30	Malis and Guyot,6 case 22	66M	One episode, 2 hours.	Acute vertigo.	Discrete kinetic signs of L upper limb.	MRI brain: normal.	TIA.	Unclear.	Unclear.
31	Malis and Guyot,6 case 23	73F	Two episodes, ‘few’ hours.	Acute vertigo.	Rotary nystagmus, internuclear ophthalmoplegia.	MRI brain: multiple ischaemic lesions to brainstem, L thalamus and R occipital lobe.	Multiple acute infarcts.	Brainstem, L thalamus and R occipital lobe.	Unclear.
32	Unal et al16	16M	Two episodes, ‘few’ minutes.	Two episodes of RVM, then syncope.	Normal examination.	MRI brain: post event: normal; 3 years post symptom onset: cortical dysplasia in L temporal and parieto-occipital regions. EEG: rare sharp and slow waves in the temporal region.	Epilepsy with cortical dysplasia.	L temporal and parieto-occipital regions.	Carbamazepine 400 mg/day.
33	Horga Hernández et al34	60M	One episode, 3 min.	Truncal ataxia, 3 min episode.	Truncal ataxia.	MRI brain: R cerebellar lesion at the territory of PICA. Angiography: Vertebral artery dissection.	Stroke from vertebral artery dissection.	R cerebellum.	Unclear.
34	Samarasekera and Dorman9	39F	One episode, 6 hours.	Memory impairment, bitemporal headache (went to sleep and RVM fully resolved when awoke).	Normal examination. Addenbrooke’s cognitive assessment: 66/100.	MRI brain: acute L medial thalamic lesion and older R thalamic lesion. EEG: slow delta transients, theta slowing in L temporal region. TOE: aneurysmal interatrial septum with large PFO.	Acute infarct, likely embolic.	L medial thalamus.	Warfarin, no new episodes at 9-month follow-up.
35	Okuyucu et al17	20M	One episode, ‘few’ seconds.	Vertigo, nausea, vomiting.	Left-sided dysmetria, gait ataxia and L horizontal nystagmus, vertical nystagmus on gazing upward, mild hypoesthesia of L arm.	MRI brain: hyperintense foci in L cerebellar white matter, multiple periventricular hyperintense lesions.	MS.	L cerebellar, periventricular.	1 g pulse intravenous methylprednisolone for 5 days.
36	de Pablo-Fernández et al35	35M	One episode, 1 hour.	Vomiting, gait instability.	Multidirectional horizontal rotary nystagmus, gait ataxia.	MRI brain: lesion to R cerebellar hemisphere. Angiography: occlusion of PICA.	Acute infarct.	R cerebellum.	75 mg/day of clopidogrel.
37	Herrero et al36	62M	Up to 20 episodes/day, ‘few’ seconds.	Multiple episodes of RVM, lasting only a few seconds.	Normal examination.	Angiography: R vertebral artery dissection.	TIAs.	Posterior ischaemia.	Anticoagulant therapy, complete recovery.
38	Crutch et al37	62F	One episode, 3–4 min.	Nil associated.	Normal examination.	MRI brain: biparietal atrophy. EEG: poorly sustained alpha rhythm with temporal lobe slowing.	Cortical atrophy, from Alzheimer’s.	Parietal lobes.	Conservative, no further episodes.
39	Deniz et al38	25F	Two episodes, 24 hours apart. Duration: first: 10 min, second: 20 min.	Blurred vision, gait disturbance and numbness in the hands.	Ataxia, hyperreflexia. Babinski’s sign was positive bilaterally, bilateral horizontal nystagmus.	MRI brain: hyperintense demyelinating lesions to brainstem and periventricular area.	MS.	Periventricular area and brainstem.	Unclear.
40	Sierra-Hidalgo et al,2 case 1	46M	One episode, 5 min.	Vertigo, nausea, vomiting.	Truncal ataxia, gaze-evoked nystagmus (R>L).	MRI brain: R cerebellum in the territory of superior cerebellar artery.	Acute infarct.	R cerebellum.	Unclear.
41	Sierra-Hidalgo et al,2 case 4	35M	One episode, 1 hour.	Nil associated.	Truncal ataxia, gaze-evoked nystagmus.	MRI brain: lateral medullary lesion. Angiography: PICA obstruction.	Acute infarct? Cryptogenic.	Lateral medulla.	Complete resolution of episodes after 24-hour intravenous heparin.
42	Sierra-Hidalgo et al,2 case 5	62M	Seven episodes, 2–3 min.	Fall from 3 m height.	Normal examination.	MRI brain: normal. Angiography: R vertebral artery dissection.	Vertebral artery dissection with TIAs.	Vertebrobasilar territory.	Unclear.
43	Sierra-Hidalgo et al,2 case 7	62M	Countless episodes, 2–3 hours.	RTI accompanying vertigo spells, no improvement with vestibular suppressants.	Normal examination.	CT brain: normal.	Ménière’s disease.	L inner ear .	Unclear.
44	Sierra-Hidalgo et al,2 case 9	60M	Three episodes, 5–7 min.	Acute vestibular syndrome, chronic R deafness.	Horizontal-torsional nystagmus towards L, R deafness.	MRI brain: R pontocerebellar angle-occupying tumour with ipsilateral cerebellar hemisphere compression and oedema.	Endolymphatic sac tumour.	Pons and cerebellum.	Surgical removal and radiated with good evolution.
45	Sierra-Hidalgo et al,2 case 10	64M	Several episodes, 10 min.	Experienced RVM with intravenous morphine on multiple occasions.	Normal examination.	CT brain: normal. EEG: normal.	Opioid toxicity.	Unclear.	Episodes improved with discontinuation of morphine.
46	Sierra-Hidalgo et al,2 case 10	82F	Three episodes, 2–3 min.	Severe bilateral presbycusis admitted with reduced mobility following a fall.	Asymmetric quadriparesis, R vibration and position hypoesthesia, L deficit to pinprick and temperature at C7–C8 level.	MRI spine: posterior-central haemorrhagic contusion at the C5 level.	Unclear.	Cervical spinal cord at the C5 level.	Conservative management.
47	Gondim et al,14 case 1	60M	Multiple episodes, 2–3 min duration at 4–5 episodes/day.	No other associated symptoms.	Brisk reflexes, otherwise normal examination. Peripheral neuropathy.	MRI brain: subacute R paramedian pontine stroke with significant involvement of the pontine tegmentum at the pontomesencephalic transition.	Acute infarct.	Pons.	Clopidogrel as stroke prophylaxis. No further episodes after gabapentin 300 mg two times per day.
48	Gondim et al,14 case 2	34F	Not specified.	Visual scotoma, blurred vision, admitted for pneumonia.	Normal examination.	MRI brain: normal.	Idiopathic intracranial hypertension.	Diffuse.	Conservative at first, then acetazolamide with no further episodes.
49	Akdal et al,10 case 5	56M	One episode, 10 hours.	Dysarthria, a few weeks preceding, patient experienced a few 1–2 s episodes of RVM.	Dysarthria, truncal ataxia to R, central vestibular nystagmus.	MRI brain: R PICA infarction.	Acute infarct.	PICA (posterior).	Unclear.
50	Stan4	50M	One episode, 2 s, while driving.	Progressively more frequent headaches over the last 2–3 weeks on a background of migraine.	Normal examination.	MRI brain: T2 hyperintense focus compatible with a small, remote lacunar infarct in R caudate head.	Acute infarct.	Caudate head.	Unclear.
51	Zeller and Stamps5	71M	Multiple episodes, length not stated.	Some muscle spasms, complete RVM 2 days post elective revision of R hip replacement.	Normal examination.	MRI brain not completed.	Unclear, possibly TIAs.	Unclear.	Several days after methimazole, episodes remitted.
52	Yap11	77M	One episode, 72 hours.	Nausea, vomiting, vertigo, dysarthria and headache on a background of preceding viral illness.	Ataxia, nystagmus, diplopia on L gaze, bidirectional nystagmus, severe R-sided paresis to mouth and eyebrow, mild dysarthria.	MRI brain: T2 hyperintensity to L posteroinferior cerebellum, inferior cerebellar vermis and R posterolateral medulla. Angiography: complete occlusion to V3, V4 of vertebral artery.	Acute infarcts.	Cerebellum, medulla.	Anticoagulation, no further episodes on follow-up at 2 years.

AICA, anterior inferior cerebellar artery; EEG, electroencephalogram; F, female; L, left; M, male; MS, multiple sclerosis; PFO, patent foramen ovale; PICA, posterior inferior cerebellar artery; R, right; RTI, room tilt illusion; RVM, reversal of vision metamorphopsia; TIA, transient ischaemic attack; TOE, trans-oesophageal echocardiogram; T2W, T2 weighed ; US, ultrasound.