Differentials
Meniere disease
SIGNS / SYMPTOMS
There is associated hearing loss, tinnitus, and aural fullness that is often exacerbated during an episode of vertigo.
Recurrent episodes of vertigo last minutes to hours and are not provoked by positional changes.[7][37]
INVESTIGATIONS
Audiogram will demonstrate a sensorineural hearing loss, usually unilateral and initially worse in the low frequencies.
Vestibular neuronitis
SIGNS / SYMPTOMS
Often a single episode of persistent vertigo lasting days. The vertigo can be exacerbated by any positional change, unlike the specific head movements that induce BPPV attacks.
INVESTIGATIONS
Little or no nystagmus or vertigo during Dix-Hallpike testing.
Labyrinthitis
SIGNS / SYMPTOMS
Often a single episode of persistent vertigo lasting days. The vertigo can be exacerbated by any positional change, unlike the specific head movements that induce BPPV attacks.
May be preceded by a nonspecific viral infection. Hearing loss is present in viral labyrinthitis.[7][37]
INVESTIGATIONS
Little or no nystagmus or vertigo during Dix-Hallpike testing.
Audiogram testing will demonstrate sensorineural hearing loss in cases of labyrinthitis.
Perilymphatic fistula
SIGNS / SYMPTOMS
Accompanied by hearing loss, tinnitus, and aural fullness.
INVESTIGATIONS
A positive fistula test (vertigo, with or without nystagmus, induced by change in ear canal pressure) can aid diagnosis of perilymphatic fistula.
Central disorders (e.g., migraines, multiple sclerosis, posterior fossa tumors, ischemic processes)
SIGNS / SYMPTOMS
BPPV is a peripheral form of vertigo and should not present with or be diagnosed in the presence of neurologic symptoms suggestive of a central disorder. Headaches, visual symptoms (double vision, visual field defects, visual loss), other sensory abnormalities such as paresthesias or deficits, and motor abnormalities all suggest a central etiology.
Vertigo not precipitated by specific head movements.
Central disorders can mimic BPPV attacks; however, symptoms tend to have a more gradual onset and to be less severe and less transient.[7][37]
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