• Van der Velde GM

• Diagnosis, Differential
• Dizziness / diagnosis
• Vertigo / diagnosis

To review recent theories regarding the aetiology and pathophysiology of benign paroxysmal positional vertigo (BPPV), including its epidemiology, clinical presentation, diagnosis, and differential diagnosis.

Data sources:

Relevant studies were identified by searching MEDLINE from 1966 - March, 1997.

Study selection:

A total of 35 studies were selected on the basis of their relevance to Part I of this review.

Data extraction:

The findings and results of relevant studies and their subsequent theories and conclusions are discussed and compiled into a general overview of BPPV.

Results of data synthesis:

BPPV is considered the most common cause of vertigo of peripheral origin. A potential causal association has been observed with numerous apparent aetiological factors, all of which may lead to peripheral vestibular trauma. Findings of densities within the posterior semi-circular canal have given rise to the most recent theories regarding the pathophysiology for BPPV, canalithiasis and cupulolithiasis.

Conclusions:

BPPV is a multiaetiological peripheral vestibular disease whose underlying cause remains an enigma. The existing evidence supports two recent pathophysiological theories, cupulolithiasis and canalithiasis. Two conditions of special concern to the chiropractor, vertebrobasilar insufficiency and cervicogenic vertigo, closely ressemble BPPV, and can be differentiated by certain identifying features. BPPV may be diagnosed clinically, after ruling out conditions in which vertigo is a central feature. A review of the treatment for BPPV, focusing on recent physical treatments will be discussed in Part II of this paper.

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