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Benign paroxysmal positional vertigo (BPPV) or benign paroxysmal vertigo (BPV) is a disorder caused by problems in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in head position.[1]
Dizziness accounts for about 6 million clinic visits in the U.S. every year, and 17–42% of these patients eventually are diagnosed with BPPV.[1] Other forms of vertigo include:
Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis.
In rare cases, the crystals themselves can adhere to a semicircular canal cupula rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles thereby inducing an immediate and maintained excitation of semicircular canal afferents afferent nerve. This condition is termed cupulolithiasis.
It can be triggered by any action which stimulates the posterior semi-circular canal which may be:
BPPV may be made worse by any number of modifiers which may vary between individuals:
Patients do not experience other neurological deficits such as numbness or weakness, and if these symptoms are present, a more concerning etiology such as posterior circulation stroke, must be considered.
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