Benign Paroxysmal Positional Vertigo (BPPV)

Most common cause of Vertigo, by far !!!
  • Usually >60 y.o., possible at any age
Keys to Diagnosis:
  • Occurs only with change of head position
  • Duration <1 min. (usually much less)
  • Recurrent repetitive attacks, for a median of 2 weeks (may last months)
  • No other neuro Sx to suggest a stroke [see below] (nausea / vomiting may occur with any etiology of vertigo)
  • Normal Neuro Exam (Cranial Nerves & Cerebellar Function)
  • Dix-Hallpike Test Positive (80% sensitivity)

Treatment:  Epley Maneuver (pt. can perform at home)

See posting Vertigo – 1.


Stroke Risk Factors
  • Age >60
  • Hypertension
  • Diabetes
  • Connective tissue disorder
Stroke Symptoms (vertebro-basilar)
  • diplopia
  • dysarthria
  • dysphagia
Suggestion of Vertebral Artery Dissection
  • Severe head or neck pain
  • Recent trauma
Signs of Vertebro-Basilar Stroke on Exam
  • EOM deficit
  • Rotary or vertical nystagmus
  • Horner’s (unilateral ptosis, miosis, absent sweating)
  • Deficits in CN 9-12 (including hoarseness)
  • Unilateral deficit in coordination (finger-to-nose or heel-down-shin tests)
  • Loss of pinprick sensation involving one side of face & opposite side of trunk
  • Abnormal Romberg with eyes open (in vestibular disease, position maintained with feet together eyes open, but not eyes closed)
  • If vertigo & nystagmus actively present, a normal horizontal Head Thrust (hHT) (or “head impulse test”)  implies stroke [click for description]