• Written By: Howard Pomeranz, MD, PhD
    Neuro-Ophthalmology/Orbit

    This is an excellent review of benign paroxysmal positional vertigo (BPPV) that discusses how to diagnose and treat the condition.

    BPPV is characterized by brief spinning sensations, usually lasting less than one minute, which are generally induced by a change in head position with respect to gravity.

    BPPV involving the posterior semicircular canal is the most common type and is usually characterized by an upward beating and torsional nystagmus that develops after a two- to five-second latency period and resolves within one minute with a positive response to the Dix-Hallpike maneuver. This test involves turning the patient’s head 45 degrees to the right while the patient is sitting upright. The patient is then moved to a supine position with the head hanging below the top end of the examination table at a 20 degree angle. The eyes are observed for 45 seconds, and if rotational nystagmus occurs, the test is considered positive for BPPV. BPPV involving the horizontal canal is characterized by either upbeating or downbeating nystagmus when the head is turned to either side while in a supine position.

    Canalith-repositioning maneuvers are effective treatments for BPPV and, according to the authors, successfully treat at least 80% of patients at the first visit. However, they say that patients should be told that BPPV may recur and require retreatment.