GPAtlas🧭 When to suspect (and when to doubt it)
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo.
• BPPV arises when displaced otoconia (calcium-carbonate “ear crystals”) drift into a semicircular canal – the posterior canal in around 85–90% of cases.
• A change in head position relative to gravity then sets off a brief, intense illusion of spinning.
The hallmark is short-lived vertigo (typically 20–30 seconds, rarely beyond a minute) triggered by specific movements:
• Rolling over in bed
• Lying down
• Sitting up
• Looking up
Symptoms settle completely between attacks (some residual unsteadiness is allowed), and there is no hearing loss or tinnitus. It is benign and self-limiting, but recurs in roughly one in three people within a year.
The two clinical skills that matter in primary care are simple:
• Confirm the diagnosis with the Dix–Hallpike manoeuvre (a positional-vertigo history alone is not enough)
• Exclude a central mimic
The pattern below is the safest way to keep both in view.
| Points towards BPPV |
|---|
|
• Brief vertigo (seconds to <1 minute) triggered by a change in head position |
|
• Symptom-free between attacks (mild residual unsteadiness acceptable) |
|
• Normal hearing, no focal neurology |
|
• Positive Dix–Hallpike – torsional, up-beating nystagmus with latency that fatigues |
| Points away – think alternative or central cause |
|---|
|
• Continuous or spontaneous vertigo lasting minutes to hours, or present at rest |
|
• Auditory symptoms (hearing loss, tinnitus, aural fullness) |
|
• Focal neurology, new headache or gait ataxia – especially with vascular risk factors |
|
• Nystagmus that is vertical, direction-changing, without latency, or non-fatiguing |
Source: AAO-HNS BPPV Clinical Practice Guideline · Bárány Society diagnostic criteria
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.