Benign paroxysmal positional vertigo

Question 1

What is benign paroxysmal positional vertigo?

Answer 1

one of the most common causes of vertigo

characterised by sudden onset of dizziness and vertigo triggered by changes in head position

Average age of onset is 55 years - less common in younger patients

Question 2

Features of paraoxysmal positional vertigo?

Answer 2

Vertigo triggered by change in head position (eg rolling over in bed or gazing upwards)

May be associated nausea

Each episode typically lasts 10-20 seconds

Positive Dix-Hallpike manoeuvre, indicated by:
- patient experiences vertigo
- rotatory nystagmus

Question 3

Prognosis of BPPV

Answer 3

good prognosis: usually resolves spontaneouslyt after a few weeks to months

Around 1/2 of people with BPPV will have a recurrence of symptoms 3-5 years after their diagnosis

Question 4

Symptomatic relief may be gained by:

Answer 4

Epley manoeuvre (successful in around 80% of cases)

Teaching the patient exercises they can do themselves at home, termed vestibular rehabilitation, for example Drandt-Daroff exercises

Medication is often prescribed (e.g. Betahistine) but it tends to be of limited value.