August
2007
BPV - Benign Positional Vertigo
Benign Positional Vertigo (BPV) is vertigo that occurs with head positional changes. Vertigo means a spinning sensation, not lightheadedness. The in peripheral BPV, the ear contains the balance center, and it senses gravity and crystals in the balance center causes the spinning sensation. In central BPV, vertigo occurs because of a problem in either the brain’s brainstem or cerebellum. Unlike central BPV in which the vertigo stays as long as the head is in the “right” position, peripheral BPV is transient – so it “burns” out after a while despite being in the same head position.
Clinical: vertigo spells usually less than a minute. BPV affects a person weeks to months without meds or intervention. Then poof! It goes away on its own. It can come back periodically and for some reason vertigo occurs mostly in the spring time.
What triggers a spell: rolling in bed, getting out of bed, looking over the shoulder, looking up.
Nausea and even vomiting can occur because dizziness can make you up-chuck.
Cause: in peripheral BPV the balance center of the inner ears (semicircular canals) have foreign bodies (like calcium crystals). These crystals hit the triggers in the canals and it gives the sense of spinning, like on a roller coaster or merry go round. The calcium crystals come from the utricular sac (where all 3 semicircular canals meet)
35% of the time there is no known reason for BPV. Some causes are head trauma, Meniere’s disease (30% of cases), history of ear surgery, vestibular neuritis, stroke to inner ear, and giant cell arteritis.
For those who have central BPV (the vertigo doesn’t diminish as long as the head stays in that position), MRI probably needs to be done to check for Chiari malformation, cerebellar degeneration, and spinocerebellar ataxia.
Diagnosis: Dix-Hallpike and Barany Maneuvers are easily done in the doctor’s office, unless you have a neck problem like Rheumatoid arthritis. Both maneuvers swing the head around to invoke vertigo. Vertigo is seen by the doctor by something called nystagmus – the eyeball swings around or back and forth very quickly.
Treatment: ENTs are known to reposition the head to get the calcium crystals out if it is peripheral BPV: Epley maneuver. Brandt-Daroff exercises as well.
Medicines are to treat the dizzy feeling and if necessary nausea and vomiting.
For those who have recurrent BPV, it comes on usually 1-3x/year but for most people BPV doesn’t haunt them for life.
Hearing test might be needed to check for Meniere’s Disease.
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drjohnhong 
Uncategorized, neurological 
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