6
Diagnosis
Table 5. Diagnostic Criteria for Posterior Canal BPPV
History Patient reports repeated episodes of vertigo with changes in head
position relative to gravity
Physical Examination Each of the following criteria is fulfilled:
• Vertigo associated with torsional (rotatory), up-beating
(toward the forehead) nystagmus is provoked by the Dix-
Hallpike test
• There is a latency period between the completion of the Dix-
Hallpike maneuver and the onset of vertigo and nystagmus
• The provoked vertigo and nystagmus increase and then
resolve within 60 seconds from the onset of the nystagmus
Table 3. Basic Differential Diagnosis of BPPV
Otologic disorders Neurologic disorders Other entities
• Meniere's disease
• Vestibular neuritis
• Labyrinthitis
• Superior canal dehiscence
syndrome
• Posttraumatic vertigo
• Perilymphatic fistula
• Inner ear lesions
• Vestibular migraine
• Posterior circulation TIA
and stroke
• Demyelinating diseases
• Central nervous system
lesions
• Vertebrobasilar
insufficiency
• Central positional vertigo
• Anxiety or panic disorder
• Cervicogenic vertigo
• Medication side effects
• Postural hypotension
• Various medical
conditions (such as toxic,
infectious and metabolic
conditions)
Table 4. Common Causes of Acute Dizziness: Differential
Diagnosis by Timing and Triggers Category
Acute vestibular
syndrome
Triggered episodic
vestibular
syndrome
Spontaneous
episodic vestibular
syndrome
Chronic vestibular
syndrome
• Vestibular neuritis
• Labyrinthitis
• Posterior
circulation stroke
• Demyelinating
diseases
• Post-traumatic
vertigo
• BPPV
• Postural
hypotension
• Perilymph fistula
• Superior canal
dehiscence
syndrome
• Vertebrobasilar
insufficiency
• Central
paroxysmal
positional vertigo
• Vestibular
migraine
• Meniere's disease
• Posterior
circulation TIA
• Medication side
effects
• Anxiety or panic
disorder
• Anxiety or panic
disorder
• Medication side-
effects
• Posttraumatic
vertigo
• Posterior fossa
mass lesions
• Cervicogenic
vertigo (variable)
