Episodic Positional Dizziness

PURPOSE OF REVIEW This article provides a summary of the evaluation and treatment of patients presenting with episodic positional dizziness.

RECENT FINDINGS Positional components are nearly ubiquitous among diagnoses of dizziness, so it can be challenging to classify patients with episodic positional dizziness simply based on the history of present illness. Overreliance on the presence of a report of positional components has likely resulted in misapplication or misinterpretation of positional testing and negative experiences with maneuvers to treat positional dizziness. The prototypical episodic positional dizziness disorder is benign paroxysmal positional vertigo (BPPV). BPPV is caused by free-floating particles in a semicircular canal that move in response to gravity. The diagnosis is made by identifying the characteristic patterns of nystagmus on the Dix-Hallpike test. Particle repositioning for BPPV is supported by randomized controlled trials, meta-analyses, and practice guidelines. Other disorders that can present with episodic positional dizziness are migraine dizziness, central lesions, and light cupula syndrome.

SUMMARY Episodic positional dizziness is a common presentation of dizziness. Neurologists should prioritize identifying and treating BPPV; doing so provides an important opportunity to deliver effective and efficient care. Providers should also recognize that positional components are common in most causes of dizziness and, therefore, should not over-rely on this part of the history of presentation when considering the diagnosis and management plan.

Address correspondence to Dr Kevin Kerber, Department of Neurology, University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109, [email protected].

RELATIONSHIP DISCLOSURE: Dr Kerber has served as a section editor for Neurology and as a consultant for Bind, Inc; has received research/grant support from the Agency for Healthcare Research and Quality (R18 HS02225), American Academy of Neurology, and National Institutes of Health (R01DC012760-06A1, R01DC012760, U01DC013778-01A1); and has received publishing royalties from Oxford University Press.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Kerber reports no disclosure.