Benign Paroxysmal Positional Vertigo

Book
In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
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Excerpt

Vertigo is the perception of motion in the absence of movement, which may be described as a sensation of swaying, tilting, spinning, or feeling unbalanced. Due to highly variable descriptions of vertigo, it is often consolidated into the umbrella descriptor 'dizziness', a very common but imprecise complaint that accounts for over three million emergency department (ED) visits annually. Dizziness can describe so many variable sensations that the use of this imprecise description becomes a dilemma that often misleads the treating provider. Vertigo can be of the vestibular or peripheral origin or be due to non-vestibular or central causes.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, accounting for over half of all cases. According to various estimates, a minimum of 20% of patients presenting to the provider with vertigo have BPPV. However, this figure could be an underestimation as BPPV is frequently misdiagnosed. It is crucial to distinguish BPPV from other causes of vertigo as the differential diagnosis includes a spectrum of disease processes ranging from benign to life-threatening. Because of the misleading and vague term 'dizziness' that patients commonly use, the provider must pin down what every patient means by it. It can be often achieved by asking the patient to describe what they are feeling without the use of the word 'dizziness.'

Barany first described BPPV in 1921. At that time, characteristic vertigo and nystagmus associated with postural changes were linked to the otolithic organs. In 1952, Dix and Hallpike, during their provocative testing, further described classic nystagmus and moved on to explain that the location of the pathology was the ear proper.

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