![]() BPPV is characterized by brief episodes of intense vertigo that is triggered by changing head position. It is distinguished from t-EVS in that the dizziness is continuous at rest and is exacerbated, but not triggered by movement.ĭefining the type of vestibular syndrome is key to the choice and interpretation of physical examination.īPPV, also known as benign positional vertigo and benign paroxysmal nystagmus, is the most common of the peripheral vestibulopathies and has a lifetime prevalence of 2.4%. Although there appear to be predisposing factors (e.g.: environmental or lifestyle factors in vestibular migraine), there is no clear trigger.Īcute Vestibular Syndrome (AVS) is a monophasic, abrupt-onset dizziness that persists for days. Spontaneous episodic vestibular syndrome (s-EVS) presents as recurrent episodes of dizziness lasting minutes to hours. The use of the term vestibular refers to the symptom of dizziness and does not imply underlying cause. The current paradigm groups the causes of acute dizziness into three vestibular syndromes based on the timing and triggers of the symptom. ![]() However, a study of more than 300 consecutive patients presenting to the ED with acute dizziness found that more than half were unable to reliably report which type of dizziness best describes their symptom and the type of dizziness was not a reliable predictor of the underlying cause. Fortunately, 90% of dizzy patients have an attributable diagnosis and 75% of the time the etiology can be revealed by history and physical examination alone.Ĭlassically, physicians were taught that the patient’s description of dizziness, vertigo (sense of spinning or motion), pre-syncope, lightheadedness, unsteadiness, is diagnostically useful information (i.e., the differential diagnoses list differs for a complaint of vertigo versus lightheadedness). In fact, vestibular disease tops the list of final diagnoses found in ER patients presenting with dizziness. Close to 20% of dizzy patients are admitted to the hospital and over a third are diagnosed with peripheral vestibular disorders. Benign paroxysmal positional vertigo (benign paroxysmal nystagmus)ĭizziness as a primary complaint accounts for 3-4% of all emergency room (ER) visits, amounting to over 150,000 ER visits annually in the United States.
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