Benign positional vertigo, its diagnosis, treatment and mimics

E C Argaet; A P Bradshaw; M S Welgampola

doi:10.1016/j.cnp.2019.03.001

Benign positional vertigo, its diagnosis, treatment and mimics

Clin Neurophysiol Pract. 2019 Apr 6:4:97-111. doi: 10.1016/j.cnp.2019.03.001. eCollection 2019.

Authors

E C Argaet^{1

2}, A P Bradshaw^{1

2}, M S Welgampola^{1

2}

Affiliations

¹ Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia.
² The Balance Clinic and Laboratory, 155 Missenden Rd Camperdown, Sydney, Australia.

Abstract

The diagnosis of benign positional vertigo (BPV) relies on a history of episodic positional vertigo and a distinctive pattern of nystagmus during provocative positional testing. The direction of the induced nystagmus is specific to the affected canal and the velocity profile reflects the underlying mechanism of canalithiasis (free-floating otoconia within the canal duct) or cupulolithiasis (otoconia adherent to the cupula). We review current theories on the pathophysiology of BPV, the clinical history and examination underlying its diagnosis, and recommended repositioning manoeuvres for each of the BPV subtypes. Disorders other than BPV which may present with a similar history and/or positional nystagmus are discussed.

Keywords: Benign paroxysmal positional vertigo; Canalithiasis; Cupulolithiasis; Positional nystagmus.

Publication types

Review