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  • Updated 12.31.2020
  • Released 07.12.2001
  • Expires For CME 12.31.2023

Positional vertigo

Introduction

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: light cupula. Patients with this condition present with persistent geotropic positional nystagmus in both lateral head positions. Alcohol consumption and vestibulocerebellar lesions need to be ruled out. This type of nystagmus can be best explained by changes of the density of the cupula that render this organ sensitive to head changes with respect to gravity.

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 (07). 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 (08); 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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