Managing patients with positional vertigo: diagnostic pitfalls and treatment

Abstract

The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.Objective: to study the common practice of managing patients with positional vertigo.Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.