Benign positional vertigo, its diagnosis, treatment and mimics

Jun 04 2020 , India

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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.



BPV is a frequently encountered cause of episodic vertigo in the neurology clinic and in primary care settings. In most cases, a diagnosis of BPV can be reached confidently with a typical history and careful examination of nystagmus during positional testing. Alternative diagnoses or comorbid conditions should always be considered when nystagmus patterns deviate from those of the most common BPV variants or persist after appropriate repositioning.

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