Benign paroxysmal positioning vertigo

Abstract

The original description of benign paroxysmal positioning vertigo (BPPV) has been variously attributed to Bárány, Adler, and others. In addition, the proper eponymic designation for the provocative positioning test used to diagnose BPPV has been unclear, because authors use a variety of different terms, including Bárány, Nylén-Bárány, Nylén, Hallpike, Hallpike-Dix, and Dix-Hallpike to refer to the procedure in current use. Based on a review of the extant medical literature, Bárány was the first to describe the condition in detail, and Dix and Hallpike were the first to clearly describe both the currently used provocative positioning technique and the essential clinical manifestations of benign paroxysmal positioning vertigo elicited by that technique. Nevertheless, despite their important contributions, neither Bárány nor Dix and Hallpike understood the pathophysiology of BPPV nor did they appreciate that the positioning techniques they used actually demonstrated pathology in the semicircular canals rather than the utricle. The modern understanding of the pathophysiology of BPPV began with Schuknecht's proposal that the dysfunction resulted from the gravity-dependent movement of loose or fixed dense material within the posterior semicircular canal ("cupulolithiasis"). Although Schuknecht's formulations were not consistent with all clinical features of the disease, they led to the modern "canalolithiasis theory" and highly effective canalith repositioning or "liberatory" maneuvers for BPPV.

A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study

“…As Benign Paroxysmal Positioning Vertigo (BPPV) has been reported post-concussion and mild head trauma (Ahn et al, 2011;Fife and Giza, 2013;Hoffer et al, 2004) a screening protocol for BPPV was undertaken. Frenzel Goggles (Interacoustics, Video Frenzel Lens VF405 Unit -Monocular Vision) were worn while the Hallpike-Dix (Bhattacharyya et al, 2008) and Head Roll tests were used to screen for BPPV in the posterior/anterior canals (Furman and Cass, 1999;Lanska and Remler, 1997) and horizontal canals (Baloh et al, 1987) respectively (present/absent).…”

Benign paroxysmal positional vertigo: Diagnostic criteria

“…Less common, BPPV can be attributed to otoconia that are attached to the cupula of a semicircular canal and render it sensitive to gravity (cupulolithiasis) [5,51,73]. The development of pathophysiological concepts of BPPV that aimed to understand the clinical features of the disease as a mechanical irritation of a semicircular canal has been an intellectual challenge [15,50]. Schuknecht coined the term cupulolithiasis on the basis of histological studies of the temporal bones from patients with BPPV [67].…”

Diagnosis and management of vertigo

“…5 The idea of the test is to make any otoconia in the posterior semicircular canal move and so provoke vertigo and nystagmus. Eventually Brandt and Daroff, and then Semont et al 6 and Epley 7 realised that making the otoconia move within the duct also allowed them to be removed from the duct, which also means that if one cannot provoke the BPPV one cannot cure it.…”