Positional vertigo

Michael von Brevern MD (Dr. von Brevern of Humboldt University has no relevant financial relationships to disclose.)
Thomas Lempert MD (Dr. Lempert of Charité University Hospital has no relevant financial relationships to disclose.)
Douglas J Lanska MD FAAN MS MSPH, editor. (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released July 12, 2001; last updated October 28, 2016; expires October 28, 2019

This article includes discussion of positional vertigo and positioning vertigo. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Positional vertigo is triggered by and occurs after a change of head position in space relative to gravity. The most common cause is benign paroxysmal positional vertigo, which can be cured highly effectively with positioning maneuvers. The differentiation from central positional vertigo is discussed by the authors. This article includes a rare differential diagnosis to positional vertigo: rotational vertebral artery syndrome. In rotational vertebral artery syndrome, vertigo is not induced by positional maneuvers but by rotation of the head to 1 side. Studies with eye movement recordings support the view that ischemia of the labyrinth leading to transient excitation of vestibular hair cells is the cause of rotational vertebral artery syndrome.

Key points

 

• Positional vertigo is triggered by and occurs after a change of head position in space relative to gravity.

 

• The most common cause of positional vertigo is due to canalolithiasis of the labyrinth.

 

• Central positional vertigo should be suspected when features of nystagmus differ from those of benign paroxysmal positional vertigo, or when brainstem and cerebellar signs are present.

Historical note and terminology

By definition, positional vertigo is triggered by and occurs after a change of head position in space relative to gravity (Bisdorff et al 2009). Some authors distinguish between positional and positioning vertigo. The former term has been used for vertigo that continues as long as the head is kept in the provocative position, whereas the latter term is used for vertigo that subsides when the head remains in the critical position (Brandt 1990); however, this nomenclature has not been widely accepted, as it does not reliably allow to separate peripheral from central vestibular disorders.

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