Table 1

Characteristics of the included reports1–17 28–38

AuthorAge and sexNumber of episodes and duration of RVMAssociated symptomsAssociated examination findingsInvestigations and imagingLikely underlying aetiologyLocationManagement
1Hornsten,29 case 6Not specifiedOne 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.
2Hornsten,29 case 13Not specifiedOne 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.
3Ropper,3 case 371FOne 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.
4Solms et al1212MMultiple 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.
5Pamir et al30Not specifiedNot specified.Not specified.Not specified.Not specified.Third ventriculostomy.Third ventricle.Unclear.
6Charles et al3148FOne 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.
7Stracciari et al,15 case 169FThree 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
Ticlopidine 250 mg daily, no further attacks at 2-year follow-up.
8Stracciari et al,15 case 252FMultiple 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.
9López et al3257MOne 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.
10Doğulu and
33FMultiple 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.
11River et al,1
case 2
70MOne 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.
12River et al,1
case 3
79MOne episode,
10 min.
Acute vertigo, nausea, vomiting,
body levitation.
Gaze apraxia, optical ataxia without simultanagnosia.Not specified.Vertebrobasilar stroke and TIA.Parietal lobes.Unclear.
13River et al,1 case 554MThree 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.
14River et al,1 case 675MTwo 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.
15Kommerell860FOne episode,
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.
16Nisipeanu et al3318MMultiple episodes over 1 year, <5 min.RVM followed by throbbing headache.Normal examination.MRI brain: normal.Migraine.Unclear.Unclear.
17Arjona and
Fernández-Romero,28 case 1
Not specifiedNot specified.Not specified.Not specified.Not specified.Herpes zoster infection of VIII nerve neuritis.Vestibular nerve.Unclear.
18Arjona and
Fernández-Romero,28 case 2
Not specifiedNot specified.Not specified.Not specified.Not specified what kind of imaging. Author states cerebellar haemorrhage.Haemorrhage.Cerebellar.Unclear.
19Gondim et al1376MMultiple 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.
20Malis and Guyot,6 case 129MOne episode,
2–3 min.
Drop attack, vertigo.Normal examination.MRI brain: normal.Ménière’s disease.R vestibular nerve.Unclear.
21Malis and Guyot,6 case 233MOne episode,
‘brief’ seconds.
Vertigo.Normal examination.MRI brain: normal.Ménière’s disease.R vestibular nerve.Unclear.
22Malis and Guyot,6 case 385FThree 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.
23Malis and Guyot,6 case 481FSeveral episodes,
Unsteady, difficulty standing, vertigo.Normal examination.MRI not performed.Ménière’s disease.L vestibular nerve.Unclear.
24Malis and Guyot,6 case 545MOne episode,
‘brief’ seconds.
Vertigo.Normal examination.MRI brain: normal.Ménière’s disease.L vestibular nerve.Unclear.
25Malis and Guyot,6 case 1458FMultiple episodes,
Positional vertigo.Positional nystagmus.MRI brain: normal.Cupulolithiasis.L vestibular nerve.Unclear.
26Malis and Guyot,6 case 1747FMultiple episodes,
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.
27Malis and Guyot,6 case 1810MMultiple episodes,
<10 min.
RVM followed by severe headaches.Normal examination.MRI brain: normal.Migraine.Unclear.Unclear.
28Malis and Guyot,6 case 2033MOne episode,
10 s.
Dizziness while driving.Normal examination.MRI brain: normal.Unclear.Unclear.Unclear.
29Malis and Guyot,6 case 2139MOne episode,
1 min.
RVM solely, 1 hour post fall on stairs.Normal examination.MRI brain: normal.Unclear? Fall.Unclear.Unclear.
30Malis and Guyot,6 case 2266MOne episode,
2 hours.
Acute vertigo.Discrete kinetic signs of L upper limb.MRI brain: normal.TIA.Unclear.Unclear.
31Malis and Guyot,6 case 2373FTwo 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.
32Unal et al1616MTwo 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.
33Horga Hernández et al3460MOne 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.
34Samarasekera and Dorman939FOne 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.
35Okuyucu et al1720MOne 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,
1 g pulse intravenous methylprednisolone for 5 days.
36de Pablo-Fernández et al3535MOne 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.
37Herrero et al3662MUp 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.
38Crutch et al3762FOne 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.
39Deniz et al3825FTwo 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.
40Sierra-Hidalgo et al,2 case 146MOne 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.
41Sierra-Hidalgo et al,2 case 435MOne 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.
42Sierra-Hidalgo et al,2 case 562MSeven 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.
43Sierra-Hidalgo et al,2 case 762MCountless 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.
44Sierra-Hidalgo et al,2 case 960MThree 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
Surgical removal and radiated with good evolution.
45Sierra-Hidalgo et al,2 case 1064MSeveral 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.
46Sierra-Hidalgo et al,2 case 1082FThree 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.
47Gondim et al,14 case 160MMultiple 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.
48Gondim et al,14 case 234FNot 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.
49Akdal et al,10 case 556MOne 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.
50Stan450MOne 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.
51Zeller and Stamps571MMultiple
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.
52Yap1177MOne 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.