Benign paroxysmal positional vertigo diagnostic study of choice: Difference between revisions

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{{CMG}}; {{AE}} {{Fs}}
== Overview ==
== Overview ==
The diagnostic study of choice for BPPV is [[patient]] history and observing [[nystagmus]] on [[Dix-Hallpike test|Dix-Hall pike maneuver]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
 
{| align="right"
|
{{#ev:youtube|https://www.youtube.com/watch?v=RNBJLed_Slc&t=4s|500}}
|}
=== Study of choice ===
=== Study of choice ===
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
The diagnostic study of choice for BPPV is [[patient]] history and observing [[nystagmus]] on [[Dix-Hallpike test|Dix-Hall pike maneuver]].<ref name="pmid20607044">{{cite journal |vauthors=Lee SH, Kim JS |title=Benign paroxysmal positional vertigo |journal=J Clin Neurol |volume=6 |issue=2 |pages=51–63 |date=June 2010 |pmid=20607044 |pmc=2895225 |doi=10.3988/jcn.2010.6.2.51 |url=}}</ref><ref name="pmid11771020">{{cite journal |vauthors=Chang MB, Bath AP, Rutka JA |title=Are all atypical positional nystagmus patterns reflective of central pathology? |journal=J Otolaryngol |volume=30 |issue=5 |pages=280–2 |date=October 2001 |pmid=11771020 |doi= |url=}}</ref><ref name="pmid24642523">{{cite journal |vauthors=Dorresteijn PM, Ipenburg NA, Murphy KJ, Smit M, van Vulpen JK, Wegner I, Stegeman I, Grolman W |title=Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo |journal=Otolaryngol Head Neck Surg |volume=150 |issue=6 |pages=919–24 |date=June 2014 |pmid=24642523 |doi=10.1177/0194599814527233 |url=}}</ref>


OR
Investigations:
* Among the [[patients]] who present with clinical [[signs]] of BPPV, the [[Dix-Hallpike test|Dix-Hallpike maneuver]] is the most specific test for the [[diagnosis]].


The following result of [gold standard test] is confirmatory of [disease name]:
===== Diagnostic results =====
* [Result 1]
The following findings are confirmatory for BPPV:
* [Result 2]
* Recurrent brief  [[vertigo]] attack which starts with certain [[head]] movements.
* [[Nystagmus]] on [[Dix-Hallpike test|Dix-Hallpike  maneuver]].


OR
===== Sequence of Diagnostic Studies =====
 
The various investigations must be performed in the following order:
[Name of the investigation] must be performed when:
* [[Patient history]]
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* [[Physical examination]] ([[Dix-Hallpike test|Dix-Hall pike maneuver]])
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
If patients doesn't respond to treatment or doesn't show the typical [[nystagmus]] on [[Dix-Hallpike test|Dix-Hall pike maneuver]], in order to rule out other abnormalities we may perform some additional test such as:
 
* [[Electronystagmography]] (ENG) or video nystagmography (VNG)
OR
* [[Audiometry]]
 
* [[Neuroimaging]]
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
For more information about these tests, [[Benign paroxysmal positional vertigo other diagnostic studies|click here]].  
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR


[Disease name] is primarily diagnosed based on the clinical presentation.
=== Diagnostic criteria for posterial canal BPPV ===


OR
Investigations:
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
==== The comparison of various diagnostic studies for [disease name] ====
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtypes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Explanation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
! style="background: #DCDCDC; text-align: center;" |History
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #F5F5F5;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* Brief recurrent vertigo attack starts with change in head position
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
! style="background: #DCDCDC; text-align: center;" |Physical exam
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #F5F5F5;" |
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* Vertigo and nystagmus after Dix-Hall pike maneuver
* Brief delay between performing Dix-Hall pike maneuver and vertigo
* The vertigo and nystagmus will resolve after 60 seconds
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
OR
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
=== Name of Diagnostic Criteria ===
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
OR
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
OR
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
OR
'''IF there are clear, established diagnostic criteria'''


The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].


OR
=== Diagnostic approach ===


The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].


OR
[[Image:Dizziness.png|550px]]


The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].


OR


'''IF there are no established diagnostic criteria'''
Diagnostic approach to a [[patient]] with [[dizziness]]:


There are no established criteria for the diagnosis of [disease name].
{{familytree/start}}
{{familytree | | | | | | | | | | A01 | | | | |A01=Patient present with [[dizziness]]<ref name="pmid27719862">{{cite journal |vauthors=Dieterich M, Staab JP, Brandt T |title=Functional (psychogenic) dizziness |journal=Handb Clin Neurol |volume=139 |issue= |pages=447–468 |date=2016 |pmid=27719862 |doi=10.1016/B978-0-12-801772-2.00037-0 |url=}}</ref><ref name="pmid28375909">{{cite journal |vauthors=Cheshire WP |title=Syncope |journal=Continuum (Minneap Minn) |volume=23 |issue=2, Selected Topics in Outpatient Neurology |pages=335–358 |date=April 2017 |pmid=28375909 |doi=10.1212/CON.0000000000000444 |url=}}</ref><ref name="Chan2009">{{cite journal|last1=Chan|first1=Yvonne|title=Differential diagnosis of dizziness|journal=Current Opinion in Otolaryngology & Head and Neck Surgery|volume=17|issue=3|year=2009|pages=200–203|issn=1068-9508|doi=10.1097/MOO.0b013e32832b2594}}</ref><ref name="Brandt2001">{{cite journal|last1=Brandt|first1=T|title=NOSOLOGICAL ENTITIES?: Cervical vertigo|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=71|issue=1|year=2001|pages=8–12|issn=00223050|doi=10.1136/jnnp.71.1.8}}</ref>}}
{{familytree | | | | | | | | | | |!| | | | | | | }}
{{familytree | | | | | | | | | | A02 | | | | | |A02=Loss of consciousness?}}
{{familytree | | | | | |,|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | }}
{{familytree | | | | | B01 | | | | | | | | | | B02 | | |B01=Yes|B02=No}}
{{familytree | | | | | |!| | | | | | | | | | | |!| | | | }}
{{familytree | | | | | |!| | | | | | | | | | | C02 | | |C02=Sense of motion/<br>spinning?}}
{{familytree | |,|-|-|-|+|-|-|-|.| | | | |,|-|-|^|-|-|.| | }}
{{familytree | D01 | | D02 | | D00 | | | D03 | | | | D04 |D01=Other|D02=Sweating<br>Heaviness sensation in the legs<br>"Tunnel" vision<br>Feeling warm or hot<br>Nausea<br>Vomiting|D00=History of seizure<br>Aura<br>Post-ictal phase<br>Uncontrollable muscle spasms<br>Drooling or frothing at the mouth<br>Teeth clenching<br>Tongue biting<br>Sudden, rapid eye movements|D03=Yes|D04=No}}
{{familytree | |!| | | |!| | | |!| | | | |!| | | | | |!| | }}
{{familytree | E01 | | E02 | | E00 | | | E03 | | | | |!| |E01=Electrolyte imbalance/<br>Intracranial process|E02=[[Syncope]]|E00=[[Seizure]]|E03=[[Vertigo]]}}
{{familytree | | | | | |!| | | |!| | | | |!| | | | | |!| | | | }}
{{familytree | | | | | M01 | | M02 | | | F02 | | | | |!| |M01=Sudden, and generally momentary, loss of consciousness, or blacking out caused by the Central Ischaemic Response|M02=Temporary abnormal electro-physiologic phenomenon of the brain, resulting in abnormal synchronization of electrical neuronal activity|F02=Sudden onset?<br>Horizental [[nystagmus]]?<br>[[Auditory]] [[symptoms]]?<br>No neurological problem?}}
{{familytree | | | | | |!| | | |!| | | | |!| | | | | |!| | | | | | | | }}
{{familytree |boxstyle=text-align: left; | | | | | X02 | | X01 | | | |!| | | | | |!| | | | | | | |X02=Causes:<br>•[[Hemorrhage]]<br>•[[Hypotension]]<br>•[[Hypoxia]]<br>•[[Pulmonary embolism]]<br>•Ruptured [[abdominal aortic aneurysm]]<br>•[[Ventricular arrhythmia]]<br>•[[Arrhythmia]]<br>•[[Medication]]<br>•[[Orthostatic hypotension]]<br>•[[Vagal]] stimulation<br>•Vertebrobasilar insufficiency|X01=Causes:<br>•[[Brain damage]] <br>•[[Congenital abnormalities]]<br>•[[Stroke]] <br>•[[Infection]]<br>•Genetic [[syndromes]]<br>•[[Brain tumor]]<br>•[[Epilepsy]]}}
{{familytree | | | | | | | | | | | | |,|-|^|-|.| | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | G01 | | G02 | | |!| | | | | | | |G01=Yes|G02=No}}
{{familytree | | | | | | | | | | | | |!| | | |!| | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | H01 | | H02 | | |!| | | | | | | |H01=Peripheral|H02=Central}}
{{familytree | | | | | | | | | | | | |!| | | |!| | | |!| | | | | | | | }}
{{familytree |boxstyle=text-align: left; | | | | | | | | | | | | I01 | | I02 | | |!| | | | | | | |I01=[[BPPV]]<br>[[Vestibular neuritis]]<br>[[HSV oticus]]<br>[[Meniere disease]]<br>[[Labyrinthine concussion]]<br>[[Perilymphatic fistula]]<br>[[Semicircular canal dehiscence syndrome]]<br>[[Vestibular paroxysma]]<br>[[Cogan syndrome]]<br>[[Vestibular schwannoma]]<br>[[Otitis media]]<br>[[Aminoglycoside toxicity]]<br>Recurrent [[vestibulopathy]]|I02=[[Vestibular migraine]]<br>[[Epileptic vertigo]]<br>[[Multiple sclerosis]]<br>[[Brain tumors]]<br>Crebellar infarction/hemorrhage<br>[[Brain stem ischemia]]<br>[[Chiari malformation]]<br>[[Parkinson]]}}
{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | |,|-|-|-|+|-|-|-|-|-|.| | }}
{{familytree | | | | | | | | | | | | | | | | J01 | | J02 | | | | J03 |J01=Hyperventilation<br>Psychiatric symptoms|J02=Balance<br>problem|J03=Sweating<br>Tunnel Vision<br>Nausea <br>Heart palpitations <br>Abdominal discomfort<br>Slurred speech}}
{{familytree | | | | | | | | | | | | | | | | |!| | | |!| | | | | |!| | | }}
{{familytree | | | | | | | | | | | | | | | | K01 | | K02 | | | | K03 | |K01=Psychogenic<br>dizziness|K02=[[Dysequilibrium]]|K03=[[Presyncope]]}}
{{familytree | | | | | | | | | | | | | | | | |!| | | |!| | | | | |!| | | }}
{{familytree | | | | | | | | | | | | | | | | L01 | | L02 | | | | L03 | |L01=Dizziness which is not characterized by true vertigo and it can be replicated by hyperventilation and psychiatric symptoms that usually precede its onset.|L02=Impaired sense or absence of balance or equilibrioception that primarily occurs during standing or walking|L03=Feeling of lightheadedness that can lead to syncope|}}
{{familytree | | | | | | | | | | | | | | | | |!| | | |!| | | | | |!| | | }}
{{familytree |boxstyle=text-align: left; | | | | | | | | | | | | | | | | Y01 | | Y02 | | | | Y03 | |Y01=Causes:<br>•[[Alcohol dependence]]<br>•[[Conversion disorder]]<br>•[[Fibromyalgia]]<br>•[[Generalized anxiety]]<br>•[[Hyperventilation]]<br>•[[Major depression]]<br>•[[Panic disorder]]|Y02=Causes:<br>•[[Arrhythmia]]<br>•[[Asthma]] exacerbation<br>•Cerebellar hemorrhage<br>•[[Compartment syndrome]]<br>•[[Endophthalmitis]]<br>•[[Epilepsy]]<br>•[[Hypoglycemia]]<br>•[[Organophosphates]]<br>•[[Cerebellar]] disorders<br>•[[Gait abnormality]]<br>•[[Hypoglycemia]]<br>•[[Paralysis]]<br>•[[Peripheral neuropathy]]<br>•Vestibular disorders<br>•Visual impairment|Y03=Causes:<br>•[[Hemorrhage]]<br>•[[Hypotension]]<br>•[[Hypoxia]]<br>•[[Pulmonary embolism]]<br>•Ruptured [[abdominal aortic aneurysm]]<br>•[[Ventricular arrhythmia]]<br>•[[Arrhythmia]]<br>•[[Medication]]<br>•[[Orthostatic hypotension]]<br>•[[Vagal stimulation]]<br>•[[Vertebrobasilar insufficiency]] }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree/end}}


==References==
==References==

Latest revision as of 14:13, 29 October 2019

Benign paroxysmal positional vertigo Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

The diagnostic study of choice for BPPV is patient history and observing nystagmus on Dix-Hall pike maneuver.

Diagnostic Study of Choice

{{#ev:youtube|https://www.youtube.com/watch?v=RNBJLed_Slc&t=4s%7C500}}

Study of choice

The diagnostic study of choice for BPPV is patient history and observing nystagmus on Dix-Hall pike maneuver.[1][2][3]

Investigations:

Diagnostic results

The following findings are confirmatory for BPPV:

Sequence of Diagnostic Studies

The various investigations must be performed in the following order:

If patients doesn't respond to treatment or doesn't show the typical nystagmus on Dix-Hall pike maneuver, in order to rule out other abnormalities we may perform some additional test such as:

For more information about these tests, click here.

Diagnostic criteria for posterial canal BPPV

Subtypes Explanation
History
  • Brief recurrent vertigo attack starts with change in head position
Physical exam
  • Vertigo and nystagmus after Dix-Hall pike maneuver
  • Brief delay between performing Dix-Hall pike maneuver and vertigo
  • The vertigo and nystagmus will resolve after 60 seconds


Diagnostic approach


Diagnostic approach to a patient with dizziness:

 
 
 
 
 
 
 
 
 
Patient present with dizziness[4][5][6][7]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Loss of consciousness?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
 
 
 
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sense of motion/
spinning?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Other
 
Sweating
Heaviness sensation in the legs
"Tunnel" vision
Feeling warm or hot
Nausea
Vomiting
 
History of seizure
Aura
Post-ictal phase
Uncontrollable muscle spasms
Drooling or frothing at the mouth
Teeth clenching
Tongue biting
Sudden, rapid eye movements
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Electrolyte imbalance/
Intracranial process
 
Syncope
 
Seizure
 
 
Vertigo
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Sudden, and generally momentary, loss of consciousness, or blacking out caused by the Central Ischaemic Response
 
Temporary abnormal electro-physiologic phenomenon of the brain, resulting in abnormal synchronization of electrical neuronal activity
 
 
Sudden onset?
Horizental nystagmus?
Auditory symptoms?
No neurological problem?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes:
•Hemorrhage
•Hypotension
•Hypoxia
•Pulmonary embolism
•Ruptured abdominal aortic aneurysm
•Ventricular arrhythmia
•Arrhythmia
•Medication
•Orthostatic hypotension
•Vagal stimulation
•Vertebrobasilar insufficiency
 
Causes:
•Brain damage
•Congenital abnormalities
•Stroke
•Infection
•Genetic syndromes
•Brain tumor
•Epilepsy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peripheral
 
Central
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BPPV
Vestibular neuritis
HSV oticus
Meniere disease
Labyrinthine concussion
Perilymphatic fistula
Semicircular canal dehiscence syndrome
Vestibular paroxysma
Cogan syndrome
Vestibular schwannoma
Otitis media
Aminoglycoside toxicity
Recurrent vestibulopathy
 
Vestibular migraine
Epileptic vertigo
Multiple sclerosis
Brain tumors
Crebellar infarction/hemorrhage
Brain stem ischemia
Chiari malformation
Parkinson
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hyperventilation
Psychiatric symptoms
 
Balance
problem
 
 
 
Sweating
Tunnel Vision
Nausea
Heart palpitations
Abdominal discomfort
Slurred speech
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Psychogenic
dizziness
 
Dysequilibrium
 
 
 
Presyncope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Dizziness which is not characterized by true vertigo and it can be replicated by hyperventilation and psychiatric symptoms that usually precede its onset.
 
Impaired sense or absence of balance or equilibrioception that primarily occurs during standing or walking
 
 
 
Feeling of lightheadedness that can lead to syncope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes:
•Alcohol dependence
•Conversion disorder
•Fibromyalgia
•Generalized anxiety
•Hyperventilation
•Major depression
•Panic disorder
 
Causes:
•Arrhythmia
•Asthma exacerbation
•Cerebellar hemorrhage
•Compartment syndrome
•Endophthalmitis
•Epilepsy
•Hypoglycemia
•Organophosphates
•Cerebellar disorders
•Gait abnormality
•Hypoglycemia
•Paralysis
•Peripheral neuropathy
•Vestibular disorders
•Visual impairment
 
 
 
Causes:
•Hemorrhage
•Hypotension
•Hypoxia
•Pulmonary embolism
•Ruptured abdominal aortic aneurysm
•Ventricular arrhythmia
•Arrhythmia
•Medication
•Orthostatic hypotension
•Vagal stimulation
•Vertebrobasilar insufficiency
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References

  1. ↑ Lee SH, Kim JS (June 2010). "Benign paroxysmal positional vertigo". J Clin Neurol. 6 (2): 51–63. doi:10.3988/jcn.2010.6.2.51. PMC 2895225. PMID 20607044.
  2. ↑ Chang MB, Bath AP, Rutka JA (October 2001). "Are all atypical positional nystagmus patterns reflective of central pathology?". J Otolaryngol. 30 (5): 280–2. PMID 11771020.
  3. ↑ Dorresteijn PM, Ipenburg NA, Murphy KJ, Smit M, van Vulpen JK, Wegner I, Stegeman I, Grolman W (June 2014). "Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo". Otolaryngol Head Neck Surg. 150 (6): 919–24. doi:10.1177/0194599814527233. PMID 24642523.
  4. ↑ Dieterich M, Staab JP, Brandt T (2016). "Functional (psychogenic) dizziness". Handb Clin Neurol. 139: 447–468. doi:10.1016/B978-0-12-801772-2.00037-0. PMID 27719862.
  5. ↑ Cheshire WP (April 2017). "Syncope". Continuum (Minneap Minn). 23 (2, Selected Topics in Outpatient Neurology): 335–358. doi:10.1212/CON.0000000000000444. PMID 28375909.
  6. ↑ Chan, Yvonne (2009). "Differential diagnosis of dizziness". Current Opinion in Otolaryngology & Head and Neck Surgery. 17 (3): 200–203. doi:10.1097/MOO.0b013e32832b2594. ISSN 1068-9508.
  7. ↑ Brandt, T (2001). "NOSOLOGICAL ENTITIES?: Cervical vertigo". Journal of Neurology, Neurosurgery & Psychiatry. 71 (1): 8–12. doi:10.1136/jnnp.71.1.8. ISSN 0022-3050.

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