Benign Positional Vertigo or BPV

Benign Positional Vertigo (BPV) - also called Benign Paroxysmal Positional Vertigo - is perhaps the most common cause of vertigo, although it is actually a syndrome and not a disease. BPV is a vertigo which is often induced while a patient turns over in bed, or gets in and out of bed. Such change in positioning moves clots or debris inside the posterior semicircular canal, setting off the vertigo. It is most often caused either by trauma or viral infection.

While it is a benign disorder, which often remits spontaneously, it presents with such severe symptomatology, that patients often think something far more serious is involved. It is known to awaken individuals from sleep. Further, it is often accompanied by severe nausea and vomiting, which may be worse than the vertigo.

It is diagnosed by the use of the Dix Halpike Maneuver. BPV is often cured, just after it is diagnosed, by another maneuver performed by the treating doctor, to liberate these clots from the posterior semicircular canal. Success on these maneuvers has been found to be between 70 and 90%. While 10-20% of those with success on these maneuvers have a recurrence within a short time, a repetition of the maneuvers often relieves these episodes.

When caused by trauma, BPV typically appears within 3 days of the head injury. When caused by viral infections, it can arise within one week or even years after the viral infection.

While it will remit spontaneously, it often reappears, with about 50% of patients having at least one future bout of PBV, and with some individuals having problems for years after the initial event.

In BPV, the positional vertigo is "fatigable," meaning that it decreases with repetition of the maneuvers. When the symptoms of positional nystagmus do not fatigue, then it is likely the cause is more serious and may be attributable to central vestibular lesions.

Understanding Subtle Brain Injury

The concussions that disable, are almost always more symptomatic at 24 hours, than at the 2-4 hour time frame when injured persons are evaluated in the emergency room. Brain injury symptoms escalate over the first 24 hours, because brain injury involves a cascade of events. It is critical that if you are still symptomatic the day after your injury, go back to the same Emergency Room, don’t wait for a doctors appointment. It is critical that the Emergency Room personnel see that the symptoms still persist or have gotten worse.

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