Neuro Diseases: Benign Paroxysmal Positional Vertigo

Introduction

Benign Paroxysmal Positional Vertigo (BPPV), sometimes simply called as benign positional vertigo as the name implies is a vertigo condition which occurs in certain positions and usually occurs on recurrent basis (paroxysmal).

Vertigo may be described as a type of dizziness where patients experience rotating or spinning experience of their body or the surroundings, or both. There are an abundant number of causes for vertigo and BPPV is an important cause especially in older people.

What causes BPPV?

Inside the inner ear there are structures what we call as semicircular canals and they help with maintaining the head and body position without causing a sense of imbalance. These canals are connected with structure called as utricle. Utricle contains small stone like structures called as otoconia (a calcium salt) and in some people they may detach from the utricle and enter the semicircular canals and then cause BPPV.

How do these patients manifest?

Recurrent episodes of vertigo are the characteristic feature of this condition. It is precipitated by sudden change in head and/or body positions including abrupt standing, turning, rolling over etc. Nausea and vomiting can occur too.

As a rule no focal neurological symptoms like weakness, numbness, facial or cranial nerve manifestations are expected with BPPV as it is a condition occurring outside the brain (in the inner ear area).

Diagnosis

A good clinical history and examination is of paramount importance for diagnosis of this condition. A clinical test called Dix Hallpike maneuver is done to see whether patients symptoms can be reproduced by moving the head and neck into certain positions, also whether a characteristic peripheral type nystagmus (rapid eye movement) can be produced.

A video nystagmography is a very useful test to support the diagnosis of BPPV/peripheral vertigo and nystagmus.

MRI of the brain (or CT) are not needed most often except in borderline cases.

Treatment

Epley (more favoured in US) & Semont are couple of vestibular exercises that may help with these patients. Medications like Meclizine, betahistine may help during very severe acute attack.

Refractory patients may require surgical treatments.

A neurologist and ENT surgeon are frequently involved in the management of patients with Benign Paroxysmal Positional Vertigo.

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