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

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


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


===== Diagnostic results =====
===== Diagnostic results =====
The following findings are confirmatory for BPPV:
The following findings are confirmatory for BPPV:
* Recurrent brief  vertigo attack which starts with certain head movements.
* Recurrent brief  [[vertigo]] attack which starts with certain [[head]] movements.
* Nystagmus on Dix-Hallpike  maneuver.
* [[Nystagmus]] on [[Dix-Hallpike test|Dix-Hallpike  maneuver]].


===== Sequence of Diagnostic Studies =====
===== Sequence of Diagnostic Studies =====
The various investigations must be performed in the following order:
The various investigations must be performed in the following order:
* Patient history
* [[Patient history]]
* Physical examination (Dix-Hall pike maneuver)
* [[Physical examination]] ([[Dix-Hallpike test|Dix-Hall pike maneuver]])
If patients doesn't respons 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:
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)
* [[Electronystagmography]] (ENG) or video nystagmography (VNG)
* Audiometry
* [[Audiometry]]
* Neuroimaging
* [[Neuroimaging]]
For more information about these tests, [[Benign paroxysmal positional vertigo other diagnostic studies|click here]].  
For more information about these tests, [[Benign paroxysmal positional vertigo other diagnostic studies|click here]].  


=== Name of Diagnostic Criteria ===
=== Diagnostic criteria for posterial canal BPPV ===


There are no established criteria for the diagnosis of BPPV.
{|
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Subtypes
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Explanation
|-
! style="background: #DCDCDC; text-align: center;" |History
| style="background: #F5F5F5;" |
* Brief recurrent vertigo attack starts with change in head position
|-
! style="background: #DCDCDC; text-align: center;" |Physical exam
| style="background: #F5F5F5;" |
* 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 ===
 
 
[[Image:Dizziness.png|550px]]
 
 
 
Diagnostic approach to a [[patient]] with [[dizziness]]:
 
{{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

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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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