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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • symptoms are precipitated by a change of position of the head with respect to gravity (1)
  • the most prominent symptom of BPPV is brief episodes (<1 min) of vertigo which occur during specific movements of the head (2):
    • vertigo that occurs in bed when a patient rolls into a lateral position
    • vertigo when the patient is gazing upward - e.g., to place an object on a shelf
    • vertigo when bending forward - e.g., to tie the shoes
  • typically, each episode of vertigo lasts only 10 to 20 seconds although the duration may be overestimated by several minutes (3)
  • these attacks occur in spells and a patient may experience several attacks a week or during the course of 1 day (3)
  • nausea is common but vomiting is rare.
    • the initial onset of vertigo is often associated with nausea, with or without vomiting.
  • lightheadedness and imbalance also may be associated (1)
  • presence of hearing loss, tinnitus, or feeling of fullness of the ears indicates another diagnosis (4)
  • it is usually a self-limiting disorder that may be present for several weeks or even years
  • remissions and recurrences occur unpredictably
  • the diagnosis of posterior BPPV is confirmed by performing the Hallpike manoeuvre (5)
    • a positive test may be seen in around 50% of patients at presentation (4)
    • helps in confirming the diagnosis of BPPV, localising the affected side and to demonstrate canalith mobility (6)
  • lateral canal BPPV (also known as horizontal canal BPPV) can be diagnosed by the supine roll test.
    • patients head is rotated 90 degrees to each side on supine position and the eyes are observed for nystagmus

Reference:

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