Okay, the Hallpike is the definitive test for BPPV, so that makes sense, but which one was positive? Head right or head left, or both (unlikely)? If it's head right, then the BPPV is in your right ear; if it was head left then the left ear is the culprit.
A 16% unilateral weakness is not significant, but which ear is the weakness in? Is it the same ear as the BPPV (I would guess that it's likely the same ear)? Just for reference, greater than 25% is considered to be significant. The directional preponderance is also insignificant. True pathologic nystagmus on downward gaze is very rare. Without seeing it, I would venture to guess that yours is not significant if there were no other central findings, which it doesn't sound like there is. Does it state what the slow-phase velocity (SPV) of the downward gaze nystagmus is? If it's less than 6 degrees/second I would definitely not worry about it. This should be measured if they are reporting it as a positive finding. Also, was this finding noted during eyes open or eyes closed testing? It should state what the conditions were when the downward gaze nystagmus was noted (i.e., "A downward beating nystagmus with an SPV of 8 deg/second was noted during gaze testing with eyes closed"... something like that).
These statements are contradictory:
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the tester said "Also had findings for central nervous system pathology." But she also said "negative for central and peripheral vestibular pathology"
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Either there IS central pathology or there isn't. What findings are they considering that point to central nervous system pathology? Perhaps they are referencing the downward gaze nystagmus? I'm not sure.
ENG or VNG testing is performed to lateralize which side is causing the symptoms and also to differentiate between central and peripheral pathologies. Central pertains to things such as space occupying lesions in the brain or degenerative diseases of the brain such as MS... anything pertaining to the brain. Peripheral refers to the vestibular structures of the inner ear or auditory cranial nerve. Those can include BPPV, Meniere's disease, or labyrinthitis. Peripheral can also be referred to as peripheral vestibular, such as in your report. Peripheral vestibular is the opposite of central, if that makes sense. There is no such thing as central vestibular.
Based on the information you've supplied, it doesn't sound to me like you have central vertigo. You have peripheral vestibular vertigo secondary to BPPV. BPPV is very easily treated with vestibular rehabilitation, usually performed by audiologists or physical therapists specially trained in vestibular rehab. I would request this if I were you as it has a very high success rate. Central vertigo is rarely treated with balance rehabilitation other than to help the patient learn to compensate.
Just a disclaimer... I am NOT attempting to give medical advice over the internet. I am only interpreting the information you've provided and I hope that helps. Let me know if you have any other questions, but it sounds to me like all you've got going on is BPPV.
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I know I have BPPV, and I understand that, but I'm trying to make sense of the other findings related to central stuff.
