Der benigne paroxysmale lagerungsschwindel

Abstract

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the vestibular labyrinth which should be suspected in all patients with a history of vertigo during changes of head position. Although patients with BPPV primarily experience brief episodes of vertigo, this disorder is also associated with postural instability, making a diagnosis sometimes difficult. BPPV is caused by misplaced calcium carbonate crystals (otoconia) in one of the semicircular canals of the inner ear that have broken free from the utricle. Diagnosis is made by instituting precipitating positioning manoeuvres to elicit the positional vertigo and nystagmus. Repositioning manoeuvres, introduced by Semont and Epley, aim to relocate the free-floating particles from the affected semicircular canal into the utricle where they will no longer cause vertiginous symptoms. Several clinical features such as latency, course and duration of nystagmus may help to distinguish BPPV from central vestibular positional nystagmus, yet only the direction of nystagmus during an attack can allow clear differentiation.