Hearingreview.com | January/February 2025

Benign paroxysmal positional vertigo (BPPV) is the No. 1 cause of vertigo. Except when it’s actually not the cause. Vertebral artery (VA) compromise can mimic BPPV and should always be considered in cases of “atypical” BPPV.

Practitioners specializing in dizziness and balance disorders have become very familiar with patients complaining of positional vertigo, and the vast majority of the time it is related to a posterior canal BPPV.1 This applies to attending staff within walk-in clinics and hospital emergency departments (ED) as well. In fact, BPPV is so prevalent it is estimated that 50% of all individuals will experience at least one occurrence by age 70.2 This all-too-common condition has unfortunately caused practitioners at times to become jaded, to the point that when there is a non-classic case it may erroneously be labeled as an “atypical” BPPV. Roberts and Gans (2008)3 have published specific nystagmus patterns for involvement of each of the semi-circular canals affected, as shown in Table 1.

Richard E Gans