Which features are characteristic of benign paroxysmal positional vertigo (BPPV)?

Which features are characteristic of benign paroxysmal positional vertigo (BPPV)?

• A. Rotational vertigo with test-related head movements, latency 5-20 seconds, torsional upbeating nystagmus
• B. Hearing loss
• C. Vertigo without posture-related triggers
• D. Central vertigo with vertical nystagmus

Answer: (A)

BPPV is a peripheral, positionally triggered cause of vertigo. It results when tiny crystals (otoconia) dislodge and enter the posterior semicircular canal, so changes in head position move endolymph and stimulate the canal, producing brief spinning vertigo and nystagmus. The most characteristic features are that the vertigo is rotational and provoked by specific head movements, such as lying down, turning in bed, or tipping the head back. There is a short delay after the head motion before symptoms begin (latency of about 5–20 seconds), and the symptoms are brief, typically lasting less than a minute, and can be reproduced or worsened with repeated testing (fatigable). The eye movement (nystagmus) pattern is usually torsional with an upbeating component when the posterior canal is stimulated, which is a hallmark of BPPV on examination such as the Dix-Hallpike test. These features help distinguish BPPV from other causes of vertigo. Hearing loss is not typical of BPPV and would suggest another diagnosis like Meniere disease or labyrinthitis. Vertigo without posture-related triggers points away from BPPV, and central vertigo (which can have vertical nystagmus and more neurologic signs) is not the same as the peripheral, canalithiasis pattern seen in BPPV.

BPPV is a peripheral, positionally triggered cause of vertigo. It results when tiny crystals (otoconia) dislodge and enter the posterior semicircular canal, so changes in head position move endolymph and stimulate the canal, producing brief spinning vertigo and nystagmus.

The most characteristic features are that the vertigo is rotational and provoked by specific head movements, such as lying down, turning in bed, or tipping the head back. There is a short delay after the head motion before symptoms begin (latency of about 5–20 seconds), and the symptoms are brief, typically lasting less than a minute, and can be reproduced or worsened with repeated testing (fatigable). The eye movement (nystagmus) pattern is usually torsional with an upbeating component when the posterior canal is stimulated, which is a hallmark of BPPV on examination such as the Dix-Hallpike test.

These features help distinguish BPPV from other causes of vertigo. Hearing loss is not typical of BPPV and would suggest another diagnosis like Meniere disease or labyrinthitis. Vertigo without posture-related triggers points away from BPPV, and central vertigo (which can have vertical nystagmus and more neurologic signs) is not the same as the peripheral, canalithiasis pattern seen in BPPV.