Positional vertigo

Introduction

Benign positional vertigo, which occurs in attacks, is a common but harmless disease, but is perceived by those affected as very unpleasant and threatening. Due to delayed diagnosis and lost time until the start of therapy, unnecessary anxiety develops, which can lead to a further worsening of the symptoms.

Synonyms

  • BPLS – benign paroxysmal positional vertigo
  • BPPV – benign paroxysmal positional vertigo
  • BPPV – benign peripheral paroxysmal positioning vertigo
  • Canalolithiasis
  • Cupolithiasis

Definition

Benign positional vertigo is the most frequently diagnosed vertigo in the neurological outpatient clinic. Although the benign positional vertigo itself can be detected in most cases with simple examination methods (positional test, Dix-Hallpike test) and, if the diagnosis is correct, a quick and harmless treatment can be applied promisingly, the clarification often takes too long or the correct diagnosis is not made at all. Sometimes further examinations are necessary for differential diagnosis of the cause of dizziness. Delayed or incorrect diagnosis increases the burden on patients, as well as the costs of unnecessary examinations and unsuccessful therapy attempts.

Symptoms

Benign positional vertigo is an episodic, head– and body-position-dependent form of rotational vertigo, the cause of which lies in the inner ear (labyrinth). The dizziness sets in with a slight delay when the head position changes rapidly, e.g. when turning around in bed, when coming up from lying down to sitting, or dizziness when bending down, and causes the affected person to feel as if he or she is being turned around his or her own axis once. Dizziness may also occur when lying down.

A typical triggering change in position is the rotation of the body towards the affected ear and/or a head rotation towards the affected side, combined with an extension of the cervical spine. Accompanying symptoms of dizziness are nystagmus (rapid, uncontrolled “eye tremor” when the head is tilted to the affected side and reversal of the eye tremor when the head is raised again) and nausea when the patient is clearly conscious. The dizziness attack of positional vertigo begins a few seconds after the start of head movement (if the movement is slow, the attack is weaker or does not occur at all) and lasts on average about 10 – 40 sec.

The intensity of the dizziness increases very quickly with the beginning of the change of position, only to slowly subside again after reaching the rest position until the patient is free of dizziness. If the dizziness is repeatedly triggered by the corresponding head or body movement, the intensity of the dizziness decreases continuously until it disappears completely. Between the vertigo attacks, the affected persons are symptom-free. Often the benign postural vertigo disappears on its own after a few weeks, but has a high recurrence rate (relapse rate). With correct diagnosis and appropriate treatment, the benign postural vertigo disappears much faster, sometimes already after a postural exercise.