Vertigo (medical)

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Vertigo is a well-recognized medical condition that consists of "illusion of movement, either of the external world revolving around the individual or of the individual revolving in space".[1] Most often, patients with vertigo "see" the room and world spinning around them, but sometimes that hallucination of movement is centered on the body, instead, and the patient feels as if he or she is spinning within the room or other setting. In severe vertigo, there is often nausea and even vomiting.


Benign paroxysmal positional vertigo (BPPV) is "the most common cause of recurrent vertigo".[2]

Unusual causes of vertigo


Benign positional vertigo

The membranous labyrinth (lateral view of the right inner ear).
• The external semicircular canal is also called the horizontal or lateral canal.
• The superior semicircular canal is also called the anterior canal.

Most cases of benign positional vertigo are due to canaliths or otoliths (calcium carbonate crystals) in the posterior canal that stimulate the cupula. Disease of the horizontal canal accounts for 10-17% of cases.[2]

Cardiac causes of dizziness can surprisingly manifest as vertigo.[3]


Skew deviation (vertical misalignment) suggests a central lesion.[4]

Benign positional vertigo

The Dix–Hallpike maneuver can diagnose positional vertigo (BPPV):[2]

  • Posterior canal BPPV causes "upbeating and torsional nystagmus with the top pole of rotation beating toward the affected (downside) ear"[2]
  • Horizontal canal BPPV causes "horizontal geotropic (toward the ground) or apogeotropic (away from the ground) direction-changing paroxysmal positional nystagmus"[2] Disease of the horizontal canal is better detected by the supine head roll test or (Pagnini–McClure maneuver).[2]
  • Anterior canal BPPV


An educational booklet may help according to a randomized controlled trial.[5]

Benign positional vertigo

Clinical practice guidelines by the American Academy of Neurology address the treatment of benign positional vertigo.[2] The guidelines state:

Evidence within a systematic review by the Cochrane Collaboration support repositioning for vertigo due to the posterior canal.[6]

More recently, head-shaking may be similarly effective for horizontal semicircular canal disease:[7]

"patients were brought into a sitting position. After pitching the head forward by approximately 30°, we moved the head sideways in a sinusoidal fashion at an approximate rate of 3 Hz for 15 seconds"


  1. Anonymous (2023), Vertigo (medical) (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Fife TD, Iverson DJ, Lempert T, et al (May 2008). "Practice Parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology 70 (22): 2067–74. DOI:10.1212/ PMID 18505980. Research Blogging.
  3. Newman-Toker, David; Fei Dy, Victoria Stanton, David Zee, Hugh Calkins, Karen Robinson (2008-12-01). "How Often is Dizziness from Primary Cardiovascular Disease True Vertigo? A Systematic Review". Journal of General Internal Medicine 23 (12): 2087-2094. DOI:10.1007/s11606-008-0801-z. Retrieved on 2008-12-18. Research Blogging.
  4. Cnyrim CD, Newman-Toker D, Karch C, Brandt T, Strupp M (2008). "Bedside differentiation of vestibular neuritis from central "vestibular pseudoneuritis"". J. Neurol. Neurosurg. Psychiatr. 79 (4): 458-60. DOI:10.1136/jnnp.2007.123596. PMID 18344397. Research Blogging.
  5. Yardley L, Barker F, Muller I, Turner D, Kirby S, Mullee M et al. (2012). "Clinical and cost effectiveness of booklet based vestibular rehabilitation for chronic dizziness in primary care: single blind, parallel group, pragmatic, randomised controlled trial.". BMJ 344: e2237. DOI:10.1136/bmj.e2237. PMID 22674920. PMC PMC3368486. Research Blogging.
  6. Hunt WT, Zimmermann EF, Hilton MP (2012). "Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV).". Cochrane Database Syst Rev 4: CD008675. DOI:10.1002/14651858.CD008675.pub2. PMID 22513962. Research Blogging.
  7. Kim JS, Oh SY, Lee SH, Kang JH, Kim DU, Jeong SH et al. (2012). "Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo.". Neurology 78 (3): 159-66. DOI:10.1212/WNL.0b013e31823fcd26. PMID 22170885. Research Blogging.