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*For medical professionals to read and refer to the nine warning signs to distinguish between BPPV and CPPV
.
In the past 10 years, benign paroxysmal positional vertigo (BPPV), commonly known as otolithiasis, and central positional vertigo (CPPV) are easily confused and misdiagnosed due to the similar characteristics of episodic, positional, clinical manifestations and displacement tests.
It caused serious consequences and caused widespread concern
.
Today, let's learn how to distinguish between the two! BPPV is a common clinical disease caused by otoliths in the utricle and balloon of the inner ear that fall off into the semicircular canals for unknown reasons, and has been widely concerned in the field of vertigo research
.
Diagnosis of BPPV, it is important to identify nystagmus Anterior/posterior semicircular canal BPPV nystagmus is characterized by vertical rotational nystagmus marked by the upper pole of the eyeball (eyebrow), with the vertical component toward the upper pole of the eyeball and the torsional component toward the ground
.
The direction of the nystagmus reversed when returning to the sitting position
.
The 1st head nystagmus is fast opposite to the ground ear (ground ear), and the person who rotates and jumps - the posterior semicircular canal BPPV
.
In-plane nystagmus away from the ground ear (ground ear), rotational dippers—characteristic of the anterior semicircular canal BPPV, as opposed to the posterior semicircular canal
.
The duration of nystagmus in canal calculi is less than 1 minute, and the duration of nystagmus in ridge-cap calculi is ≥1 minute
.
If the nystagmus is to the ground, the stronger side of the nystagmus is the affected side, which is horizontal canallithiasis
.
If dorsal nystagmus, the weaker side of the nystagmus is the affected side, which is ridge cap calculi
.
CPPV is a central origin of vertigo, and the common lesions are: the dorsal lateral part of the fourth ventricle, the dorsal cerebellar vermis, the cerebellar nodular lobe and the lingual lobe
.
So how to distinguish between the two? Warning sign 1: Hearing impairment BPPV is a lesion involving the semicircular canals, generally not involving hearing
.
If accompanied by hearing symptoms, be alert to diseases other than BPPV, such as CPPV, or BPPV is accompanied by other diseases, especially internal auditory canal and cerebellopontine triangle (CPA) tumors, cerebrovascular disease
.
Warning signal 2: Balance disorder BPPV is an induced irritative lesion formed by the falling otolith on the semicircular canal where it is located
.
In the absence of previous recurrent episodes, there is usually no evidence of organic vestibular impairment
.
At this time, symptoms and signs of balance disorders are usually not present
.
The presence of Romberg-positive or Tandem Romberg-positive usually indicates that the brainstem and cerebellum may be affected, and alertness should be increased
.
BBPV is unlikely if the patient is wheelchair-bound or carried on a stretcher
.
Early warning signal 3: Downward nystagmus (DBN) occurs in the median position in situ, and forward gaze is called in situ gazing.
Downward nystagmus occurs in in situ gazing, indicating central source damage
.
Warning Sign 4: Positional Downward Nystagmus (pDBN) Special attention is paid to pDBN
.
DBN does not appear during in situ fixation, but DBN appears during Dix-Hallpike or Superior ReII displacement tests in a certain body position, called pDBN
.
The nystagmus produced by any peripheral semicircular canal disease is consistent with the plane of the stimulated semicircular canal
.
When the posterior vertical semicircular canal is stimulated, upward rotation nystagmus occurs, and when the horizontal semicircular canal is stimulated, horizontal nystagmus occurs
.
If pDBN appears, it suggests a central disorder
.
Early warning signal 5: Nystagmus such as pure up-down nystagmus and pure rotational nystagmus can appear in all directions of gaze, and are generally of central origin
.
A single semi-regular peripheral disorder is unlikely to produce pure upward and downward nystagmus, and pure rotational nystagmus
.
Tips: As long as episodic positional nystagmus occurs in the displacement test, BPPV can be diagnosed
.
Look for directions! Warning signal 6: CPPV prompts Figure 1 Nystagmus that is inconsistent with the stimulated semicircular canal plane Dix-Hallpike maneuver stimulates the vertical semicircular canal, and upward nystagmus with a rotating component (uprotation nystagmus) occurs, because the posterior semicircular canal is excited on the same side The cause of the superior oblique muscle and the contralateral inferior rectus muscle, if it induces downward nystagmus (positional downward nystagmus), suggests a central source of damage
.
In the horizontal semicircular canal displacement test, the induced nystagmus was horizontal nystagmus, and rotational nystagmus was unlikely to occur, but pure rotational nystagmus appeared, suggesting a central source of damage
.
Warning sign 7: Positional or displacement nystagmus, not accompanied by dizziness.
This is mostly one of the signs of central source damage: it may be related to the vestibular reflex caused by the disinhibition of the head, eyes, body and their perception during positional response.
Vestibular tone imbalance
.
In addition, it is unusual for a patient with BPPV to have marked nausea without markedly intense nystagmus and requires further investigation
.
Tips: Positional or displacement test nystagmus is not accompanied by vertigo, and it is unusual for vertigo not to be accompanied by nystagmus
.
Warning sign 8: Positional nystagmus cannot be suppressed by fixation.
If it can be suppressed by visual fixation, it is usually peripheral
.
If not suppressed by visual fixation, it is usually of central origin
.
This is another sign to watch out for
.
Warning signal 9: Ineffective or unresponsive otolith repositioning BPPV is a vertigo disease caused by the sloughed otolith entering the semicircular canal and stimulating the corresponding semicircular canal
.
After the otolith is reset, the stimulation is eliminated, the condition is relieved, and most of them have a better response to treatment
.
If there is no response to reduction therapy, other possibilities need to be considered, and the first thing to rule out is a central source of disease
.
When necessary, other relevant examinations should be carried out in time to avoid misdiagnosis
.
The above 9 early warning signals put forward the key points for understanding the essential difference between BPPV and CPPV, and need to be highly vigilant
.
Distinguishing central and peripheral is the key to differential diagnosis
.
The basic path of physical examination for vertigo is attached at the end of the article: Figure 2 The basic path of physical examination APP”, search the title to watch the full version of the lecture video
.
●Consensus on the diagnosis and treatment of dizziness/vertigo in the elderly, insightful analysis of mind maps ●The most complete mind map of "Dizziness/Vertigo Consultation", hurry up and collect it! ●Dizziness diagnosis process and ideas, explained thoroughly!
.
In the past 10 years, benign paroxysmal positional vertigo (BPPV), commonly known as otolithiasis, and central positional vertigo (CPPV) are easily confused and misdiagnosed due to the similar characteristics of episodic, positional, clinical manifestations and displacement tests.
It caused serious consequences and caused widespread concern
.
Today, let's learn how to distinguish between the two! BPPV is a common clinical disease caused by otoliths in the utricle and balloon of the inner ear that fall off into the semicircular canals for unknown reasons, and has been widely concerned in the field of vertigo research
.
Diagnosis of BPPV, it is important to identify nystagmus Anterior/posterior semicircular canal BPPV nystagmus is characterized by vertical rotational nystagmus marked by the upper pole of the eyeball (eyebrow), with the vertical component toward the upper pole of the eyeball and the torsional component toward the ground
.
The direction of the nystagmus reversed when returning to the sitting position
.
The 1st head nystagmus is fast opposite to the ground ear (ground ear), and the person who rotates and jumps - the posterior semicircular canal BPPV
.
In-plane nystagmus away from the ground ear (ground ear), rotational dippers—characteristic of the anterior semicircular canal BPPV, as opposed to the posterior semicircular canal
.
The duration of nystagmus in canal calculi is less than 1 minute, and the duration of nystagmus in ridge-cap calculi is ≥1 minute
.
If the nystagmus is to the ground, the stronger side of the nystagmus is the affected side, which is horizontal canallithiasis
.
If dorsal nystagmus, the weaker side of the nystagmus is the affected side, which is ridge cap calculi
.
CPPV is a central origin of vertigo, and the common lesions are: the dorsal lateral part of the fourth ventricle, the dorsal cerebellar vermis, the cerebellar nodular lobe and the lingual lobe
.
So how to distinguish between the two? Warning sign 1: Hearing impairment BPPV is a lesion involving the semicircular canals, generally not involving hearing
.
If accompanied by hearing symptoms, be alert to diseases other than BPPV, such as CPPV, or BPPV is accompanied by other diseases, especially internal auditory canal and cerebellopontine triangle (CPA) tumors, cerebrovascular disease
.
Warning signal 2: Balance disorder BPPV is an induced irritative lesion formed by the falling otolith on the semicircular canal where it is located
.
In the absence of previous recurrent episodes, there is usually no evidence of organic vestibular impairment
.
At this time, symptoms and signs of balance disorders are usually not present
.
The presence of Romberg-positive or Tandem Romberg-positive usually indicates that the brainstem and cerebellum may be affected, and alertness should be increased
.
BBPV is unlikely if the patient is wheelchair-bound or carried on a stretcher
.
Early warning signal 3: Downward nystagmus (DBN) occurs in the median position in situ, and forward gaze is called in situ gazing.
Downward nystagmus occurs in in situ gazing, indicating central source damage
.
Warning Sign 4: Positional Downward Nystagmus (pDBN) Special attention is paid to pDBN
.
DBN does not appear during in situ fixation, but DBN appears during Dix-Hallpike or Superior ReII displacement tests in a certain body position, called pDBN
.
The nystagmus produced by any peripheral semicircular canal disease is consistent with the plane of the stimulated semicircular canal
.
When the posterior vertical semicircular canal is stimulated, upward rotation nystagmus occurs, and when the horizontal semicircular canal is stimulated, horizontal nystagmus occurs
.
If pDBN appears, it suggests a central disorder
.
Early warning signal 5: Nystagmus such as pure up-down nystagmus and pure rotational nystagmus can appear in all directions of gaze, and are generally of central origin
.
A single semi-regular peripheral disorder is unlikely to produce pure upward and downward nystagmus, and pure rotational nystagmus
.
Tips: As long as episodic positional nystagmus occurs in the displacement test, BPPV can be diagnosed
.
Look for directions! Warning signal 6: CPPV prompts Figure 1 Nystagmus that is inconsistent with the stimulated semicircular canal plane Dix-Hallpike maneuver stimulates the vertical semicircular canal, and upward nystagmus with a rotating component (uprotation nystagmus) occurs, because the posterior semicircular canal is excited on the same side The cause of the superior oblique muscle and the contralateral inferior rectus muscle, if it induces downward nystagmus (positional downward nystagmus), suggests a central source of damage
.
In the horizontal semicircular canal displacement test, the induced nystagmus was horizontal nystagmus, and rotational nystagmus was unlikely to occur, but pure rotational nystagmus appeared, suggesting a central source of damage
.
Warning sign 7: Positional or displacement nystagmus, not accompanied by dizziness.
This is mostly one of the signs of central source damage: it may be related to the vestibular reflex caused by the disinhibition of the head, eyes, body and their perception during positional response.
Vestibular tone imbalance
.
In addition, it is unusual for a patient with BPPV to have marked nausea without markedly intense nystagmus and requires further investigation
.
Tips: Positional or displacement test nystagmus is not accompanied by vertigo, and it is unusual for vertigo not to be accompanied by nystagmus
.
Warning sign 8: Positional nystagmus cannot be suppressed by fixation.
If it can be suppressed by visual fixation, it is usually peripheral
.
If not suppressed by visual fixation, it is usually of central origin
.
This is another sign to watch out for
.
Warning signal 9: Ineffective or unresponsive otolith repositioning BPPV is a vertigo disease caused by the sloughed otolith entering the semicircular canal and stimulating the corresponding semicircular canal
.
After the otolith is reset, the stimulation is eliminated, the condition is relieved, and most of them have a better response to treatment
.
If there is no response to reduction therapy, other possibilities need to be considered, and the first thing to rule out is a central source of disease
.
When necessary, other relevant examinations should be carried out in time to avoid misdiagnosis
.
The above 9 early warning signals put forward the key points for understanding the essential difference between BPPV and CPPV, and need to be highly vigilant
.
Distinguishing central and peripheral is the key to differential diagnosis
.
The basic path of physical examination for vertigo is attached at the end of the article: Figure 2 The basic path of physical examination APP”, search the title to watch the full version of the lecture video
.
●Consensus on the diagnosis and treatment of dizziness/vertigo in the elderly, insightful analysis of mind maps ●The most complete mind map of "Dizziness/Vertigo Consultation", hurry up and collect it! ●Dizziness diagnosis process and ideas, explained thoroughly!
