
Contents
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Introduction Introduction
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Aetiology and pathogenesis Aetiology and pathogenesis
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Canalolithiasis Canalolithiasis
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Cupulolithiasis Cupulolithiasis
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Diagnosis and pathomecanism Diagnosis and pathomecanism
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Symptoms Symptoms
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Clinical features Clinical features
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Posterior canal Posterior canal
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Lateral canal Lateral canal
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Geotropic variant Geotropic variant
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Apogeotropic variant Apogeotropic variant
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The ‘null point’ phenomenon The ‘null point’ phenomenon
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Pseudo-spontaneous nystagmus and movements of the head in the sagittal plane Pseudo-spontaneous nystagmus and movements of the head in the sagittal plane
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Anterior canal BPPV and positional downbeating PN Anterior canal BPPV and positional downbeating PN
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Differential diagnosis of positional vertigo Differential diagnosis of positional vertigo
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The treatment of BPPV The treatment of BPPV
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Treatment of PC-BPPV Treatment of PC-BPPV
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Sémont manoeuvre Sémont manoeuvre
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Epley’s procedure Epley’s procedure
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Treatment of LC-BPPV Treatment of LC-BPPV
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Geotropic variant Geotropic variant
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Apogeotropic variant Apogeotropic variant
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Treatment of AC-BPPV Treatment of AC-BPPV
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Treatment of apogeotropic PC-BPPV Treatment of apogeotropic PC-BPPV
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References References
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19 Benign paroxysmal positional vertigo: A guide to diagnosis and treatment
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Published:March 2025
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Abstract
Benign paroxysmal positional vertigo (BPPV) is a disorder of the labyrinth attributed to mechanical stimulation of the vestibular receptors of the semicircular canals. The cause is dislodged otoconia and fragments of the otolithic membrane from the utricular macula that enter and become trapped in the semicircular canals. BPPV is the most frequent cause of vertigo in adults. Paroxysmal positional nystagmus is the pathognomonic sign of the disorder. BPPV generally remits spontaneously after days to weeks, but recurs in around half of patients. Physical manoeuvres are the mainstay of treatment of BPPV; their goal is to move the otoconia out of the canals. Most patients can be diagnosed easily without any special tests, and treated effectively with particle repositioning manoeuvres. Physicians, however, must be vigilant for rare but more ominous central disorders when the pattern of positional nystagmus is atypical, or the patient does not respond to treatment.
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