What is the pathology and treatment of benign paroxysmal positional vertigo/dizziness?

Updated: Jun 26, 2018
  • Author: Wayne T Shaia, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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The pathology and treatment of benign paroxysmal positional vertigo/dizziness includes the following:

  • The most common cause of true vertigo is benign paroxysmal positional vertigo (BPPV). The classic history of an individual presenting with BPPV consists of symptoms of acute vertigo lasting less than 1 minute that occurs when the patient lies supine, sits up, rolls over in bed, or tilts his or her head backward. After the patient assumes one of these positions, vertigo and torsional nystagmus usually begin within 1-4 seconds. This latency period also applies to a reversal of nystagmus when the patient returns to the upright position.

  • BPPV is often related to head trauma; however, it is frequently is found in older patients without a clear history of head trauma. Particles (probably dislodged otoconia) that become trapped in the posterior semicircular canal cause BPPV. Although the posterior semicircular canal is the most common site of the lesion, in rare cases patients have horizontal or superior canal variants.

  • Although the condition may spontaneously resolve in many patients, others seek medical care for this unsettling problem. Medications, such as meclizine or benzodiazepines, are usually not helpful in the treatment of BPPV. The most effective treatment is repositioning of the canalith, which is an office-based maneuver in which the particles are shifted out of the semicircular canal and into the vestibule, where they do not cause symptoms.

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