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Benign paroxysmal positional vertigo

Author
Jason JS Barton, MD, PhD, FRCPC
Section Editors
Michael J Aminoff, MD, DSc
Daniel G Deschler, MD, FACS
Paul W Brazis, MD
Deputy Editor
Janet L Wilterdink, MD

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is the most common form of positional vertigo, accounting for nearly one-half of patients with peripheral vestibular dysfunction. It is most commonly attributed to calcium debris within the posterior semicircular canal, known as canalithiasis. While symptoms can be troublesome, the disorder usually responds to treatment with particle-repositioning maneuvers, an office-based procedure and one that patients can be taught to perform at home.

BPPV will be reviewed here. Other causes of vertigo and an overview of the approach to the patient with vertigo are discussed separately. (See "Pathophysiology, etiology, and differential diagnosis of vertigo" and "Evaluation of the patient with vertigo".)

EPIDEMIOLOGY

In a population-based survey, the lifetime prevalence of benign paroxysmal positional vertigo (BPPV) was 2.4 percent [1]. The one-year prevalence of BPPV increased with age and was seven times higher in those older than 60 years, compared with those aged 18 to 39 years. BPPV was more common in women than men in all age groups, with a reported ratio of 2:1 to 3:1 [1,2]. Other risk factors, which may be pathogenic are discussed in the next section.

PATHOGENESIS

Benign paroxysmal positional vertigo (BPPV) is commonly attributed to canalithiasis, ie, calcium debris within the semicircular canal [3]. This debris likely represents loose otoconia (calcium carbonate crystals) within the utricular sac. In one study, these were identified intraoperatively in 8 of 26 patients undergoing surgery for refractory BPPV and in none of 73 patients undergoing labyrinthine surgery for other indications [4].

The semicircular canals normally detect angular head accelerations. Heavy debris in the canal causes inappropriate movement of the endolymph with linear accelerations, such as gravity, and causes the erroneous sensation of spinning when the head shifts with respect to gravity. (See "Overview of nystagmus", section on 'Basic clinical vestibular physiology'.)

                            

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Literature review current through: Nov 2016. | This topic last updated: Fri Jan 08 00:00:00 GMT+00:00 2016.
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