Barany elicited vertigo in a 27-year-old woman by turning her head from side to side in a supine position and noted “…there appeared a strong rotatory nystagmus to the right with a vertical component upwards, which when looking to the right was purely rotatory, and when looking to the left was purely vertical.” In 1952 Margaret Dix (1911–1981) and Charles Hallpike (1900–1979) at Queen Square Hospital, based on 100 patients, presented a symptomatological definition and a provocative positional test for what they called “positional nystagmus of the benign positional type.” For symptoms they note: “The story given by the patient is characteristically that the giddiness comes on when he lies down in bed or when he turns over in bed, or when such a position is taken up during the day for instance lying down beneath a car or in throwing the head backward to paint a ceiling.” Their diagnostic test: “….the patient is first seated upon the couch with the head turned to one side and the gaze fixed firmly on the examiner’s forehead. ” In the medical literature the first descriptions of positionally induced vertigo are attributed to Adler and later Barany, who believed it was a disorder of the otolith organs.
One pain is lessen’d by another’s anguish turn giddy, and be holp by backwards turning. The earliest reference to it may have been by Shakespeare in “Romeo and Juliet” In Act I, Scene II Bevolio says “Tut man, one fire burns out another’s burning. The symptoms can last for days, weeks, months, or years, or be recurrent over many years. When severe, vertigo is provoked by most head movements, giving an impression of continuous vertigo. Moderate symptoms are frequent positional attacks with disequilibrium between. Mild symptoms are inconsistent positional vertigo. The cardinal symptom is sudden vertigo induced by a change in head position: turning over in bed, lying down in bed (or at the dentist or hairdresser), looking up, stooping, or any sudden change in head position. History and Pathophysiologyīenign paroxysmal positional vertigo (BPPV) is the most common vertiginous disorder in the community. Future directions for research are discussed. Diagnostic strategies and the simplest “office” treatment techniques are described. Unusual patterns of nystagmus and nonrepsonse to treatment may suggest central pathology. BPPV symptoms can resolve spontaneously but can last for days, weeks, months, and years. Subsequently, it has been established that the symptoms are attributable to detached otoconia in any of the semicircular canals. The cardinal features and a diagnostic test were clarified in 1952 by Dix and Hallpike.
Misdiagnosis can result in unnecessary tests. It is likely to be a cause of falls and other morbidity in the elderly. There is a wide spectrum of severity from inconsistent positional vertigo to continuous vertigo provoked by any head movement. In younger individuals it is the commonest cause of vertigo following head injury. It most often occurs spontaneously in the 50 to 70 year age group. BPPV is the most common cause of vertigo.