Benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) describes a condition in which there is:

• Rotational Vertigo 
• Provoked by turning head/change in position 
• Lasts around 10-30 seconds 
• Possibly with nausea 

Most patients are over 40 years of age 

Women > men (2:1)

Aetiology – believed to be due to free-floating endolymph particles in semi-circular canal. 

• Most cases (60-70%) are idiopathic. 
• Secondary BPPV may be due to 
• Head trauma (7-17% of all cases of BPPV) 
• Viral (up to 15% of all cases of BPPV)
• Meniere’s disease (around 5% of cases of BPPV) 
• Migraines (less than 5% of all cases of BPPV) 

Diagnosis:  Dix-Hallpike manoeuvre – look for nystagmus 

Treatment: Epley’s manoeuvre – series of head movements with the purpose of encouraging any foreign material out of the canal and into the utricle 

References

Lempert, T., Gresty, M. and Bronstein, A. Benign positional vertigo: recognition and treatment. BMJ. 1995; 311(7003): 489-491. 

Parnes, L., Agrawal, S. and Atlas, J. Diagnosis and management of benign paroxysmal positional vertigo. CMAJ. 2003; 169(7): 681-693.