How to identify 2 different types of positional vertigo?

Vertigo is a movement or positional illusion caused by the disturbance of the body's spatial orientation
.

According to statistics , dizziness is the main complaint in about 5% to 10% of neurology outpatient clinics, about 6.

Vertigo is a movement or positional illusion caused by the disturbance of the body's spatial orientation

Everyone is familiar with benign paroxysmal positional vertigo (BPPV), which is one of the most common clinical peripheral vertigo diseases, with a cumulative incidence of 10% in the population.

It is also a hot issue in the field of vertigo research in recent years [2]

Everyone is familiar with benign paroxysmal positional vertigo (BPPV), which is one of the most common clinical peripheral vertigo diseases, with a cumulative incidence of 10% in the population.
It is also a hot issue in the field of vertigo research in recent years [2]

 

Although CPPV originates from lesions of the central system, it may only present with paroxysmal positional vertigo at the time of onset, that is, only isolated vertigo without obvious neurological damage.
The clinical manifestations have many similarities with BPPV.
, is very easy to confuse
.

Therefore, today we will comprehensively review the clinical features of CPPV and the points of differentiation from BPPV

Although CPPV originates from lesions of the central system, it may only present with paroxysmal positional vertigo at the time of onset, that is, only isolated vertigo without obvious neurological damage.

Causes of CPPV

Causes of CPPV Causes of CPPV

 

Central paroxysmal positional vertigo (CPPV), also known as malignant paroxysmal positional vertigo, is rare in clinical practice
.

The lesions are mainly in the brainstem and cerebellum, such as dorsolateral fourth ventricle, pons, medulla oblongata, cerebellar vermis, follicle and nodules [3]

Central paroxysmal positional vertigo (CPPV), also known as malignant paroxysmal positional vertigo, is rare in clinical practice

Nystagmus mechanism and characteristics of CPPV

Nystagmus mechanism and characteristics of CPPV Nystagmus mechanism and characteristics of CPPV

 

At present, it is believed that nystagmus involving the pons, medulla and cerebellum basically involves the central velocity storage mechanism (VSM) pathway, resulting in impaired function of the latter [2]
.

The VSM is composed of the medial vestibular nucleus, sublingual nucleus previa, cerebellar nodules and cerebellar vermis located in the brainstem, and provides a modified acceleration signal to the medial vestibular nucleus to improve the accuracy of gravity assessment after rotation

At present, it is believed that nystagmus involving the pons, medulla and cerebellum basically involves the central velocity storage mechanism (VSM) pathway, resulting in impaired function of the latter [2]

Unlike the nystagmus of BPPV, the typical nystagmus latency of CPPV is short, and the duration is less than 1min
.

Nystagmus does not only appear in one specific location, but can appear in multiple locations
.
Depending on the location of the lesion, it can be vertical, horizontal or rotational
.
However, the intensity of nystagmus did not increase or decrease significantly, that is, nystagmus did not have fatigue after multiple trials
.
When the patient lies on the affected side, nystagmus occurs immediately after reaching the evoked position, and when the patient returns from the lying position to the sitting position, the direction of the nystagmus does not change in the opposite direction.
Jump type", "clockwise" and "counterclockwise" changes [4]
.

Unlike the nystagmus of BPPV, the typical nystagmus latency of CPPV is short, and the duration is less than 1min
.
Nystagmus does not only appear in one specific location, but can appear in multiple locations
.
Depending on the location of the lesion, it can be vertical, horizontal or rotational
.
However, the intensity of nystagmus did not increase or decrease significantly, that is, nystagmus did not have fatigue after multiple trials
.
When the patient lies on the affected side, nystagmus occurs immediately after reaching the evoked position, and when the patient returns from the lying position to the sitting position, the direction of the nystagmus does not change in the opposite direction.
Jump type", "clockwise" and "counterclockwise" changes [4]
.

 

Differential diagnosis of BPPV and CPPV

Differential Diagnosis of BPPV and CPPV Differential Diagnosis of BPPV and CPPV

 

Although patients with BPPV are in great pain, feel a strong turmoil, cannot walk upright normally, cannot work and live normally, have balance dysfunction, and may be accompanied by autonomic nervous reactions such as nausea and vomiting, but in general, BPPV It is a benign peripheral disease and does not pose a threat to the patient's life
.
However, CPPV often involves the brainstem, cerebellum and other key parts of the life center, and is often caused by tumors.
Therefore, if it is not treated in time, it may have serious consequences for patients
.

Although patients with BPPV are in great pain, feel a strong turmoil, cannot walk upright normally, cannot work and live normally, have balance dysfunction, and may be accompanied by autonomic nervous reactions such as nausea and vomiting, but in general, BPPV It is a benign peripheral disease and does not pose a threat to the patient's life
.
However, CPPV often involves the brainstem, cerebellum and other key parts of the life center, and is often caused by tumors.
Therefore, if it is not treated in time, it may have serious consequences for patients
.

 

Both BPPV and CPPV are vertigo induced by postural changes
.
However, BPPV patients also complained of strong dizziness when positional changes produced nystagmus, while CPPV patients had relatively mild vertigo, and may even have nystagmus without obvious dizziness
.
At the same time, BPPV has clear diagnostic criteria, so nystagmus must meet the diagnostic characteristics of BPPV
.
For the paroxysmal positional nystagmus and transient vertigo induced during the test, although the nature of nystagmus is consistent with the characteristics of BPPV, if the reduction treatment is ineffective, it still suggests the possibility of CPPV
.

Both BPPV and CPPV are vertigo induced by postural changes
.
However, BPPV patients also complained of strong dizziness when positional changes produced nystagmus, while CPPV patients had relatively mild vertigo, and may even have nystagmus without obvious dizziness
.
At the same time, BPPV has clear diagnostic criteria, so nystagmus must meet the diagnostic characteristics of BPPV
.
For the paroxysmal positional nystagmus and transient vertigo induced during the test, although the nature of nystagmus is consistent with the characteristics of BPPV, if the reduction treatment is ineffective, it still suggests the possibility of CPPV
.

 

Of course, BPPV shares some similarities with CPPV
.
For example, dizziness occurs repeatedly, and the patient complains that the vertigo is related to the change of head position.
There is no ear discomfort such as tinnitus, ear fullness, and hearing loss during vertigo, and ataxia, nausea, and vomiting occur when vertigo is severe.
, No history of headache and motion sickness
.

Of course, BPPV shares some similarities with CPPV
.
For example, dizziness occurs repeatedly, and the patient complains that the vertigo is related to the change of head position.
There is no ear discomfort such as tinnitus, ear fullness, and hearing loss during vertigo, and ataxia, nausea, and vomiting occur when vertigo is severe.
, No history of headache and motion sickness
.

 

The following table summarizes the key points for distinguishing BPPV and CPPV:

The following table summarizes the key points for distinguishing BPPV and CPPV:

 

 

 

To sum up, when a patient has positional vertigo, the direction of nystagmus, the appearance and duration of nystagmus, and the change in intensity of nystagmus need to be analyzed in detail , rather than a general diagnosis of positional vertigo.
Benign paroxysmal positional vertigo
.

To sum up, when a patient has positional vertigo, the direction of nystagmus, the appearance and duration of nystagmus, and the change in intensity of nystagmus need to be analyzed in detail , rather than a general diagnosis of positional vertigo.
Benign paroxysmal positional vertigo
.

 

 references:

[1] Liu Chang, Liu Daxin, Ding Lei, et al.
Analysis of the incidence and disease characteristics of vertigo[J].
Chinese Journal of Otolaryngology Head and Neck Surgery, 2013, 48(10): 862-864.
DOI: 10.
3760/cma.
j.
issn.
1673-0860.
2013.
10.
021

[1] Liu Chang, Liu Daxin, Ding Lei, et al.
Analysis of the incidence and disease characteristics of vertigo[J].
Chinese Journal of Otolaryngology Head and Neck Surgery, 2013, 48(10): 862-864.
DOI: 10.
3760/cma.
j.
issn.
1673-0860.
2013.
10.
021

[2] Bisdorff A.
Vestibular symptoms and history taking[J].
Handb Clin Neurol, 2016, 137: 83-90.
DOI: 10.
1016/B978-0-444-63437-5.
00006-6

[2] Bisdorff A.
Vestibular symptoms and history taking[J].
Handb Clin Neurol, 2016, 137: 83-90.
DOI: 10.
1016/B978-0-444-63437-5.
00006-6

[3] Neurology Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Neurology.
Multidisciplinary expert consensus on the diagnosis and treatment of vertigo [J].
Chinese Journal of Neurology, 2017, 50(11): 805-809.
DOI:10.
3760/cma.
j .
issn.
1006-7876.
2017.
11.
002

[3] Neurology Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Neurology.
Multidisciplinary expert consensus on the diagnosis and treatment of vertigo [J].
Chinese Journal of Neurology, 2017, 50(11): 805-809.
DOI:10.
3760/cma.
j .
issn.
1006-7876.
2017.
11.
002 Consensus

[4] Vertigo Professional Committee of China Medical Education Association, Emergency Physician Branch of Chinese Medical Doctor Association.
Expert consensus on emergency diagnosis and treatment of vertigo.
Chinese Journal of Emergency Medicine, 2018, 27(3): 248-253.

[4] Vertigo Professional Committee of China Medical Education Association, Emergency Physician Branch of Chinese Medical Doctor Association.
Expert consensus on emergency diagnosis and treatment of vertigo.
Chinese Journal of Emergency Medicine, 2018, 27(3): 248-253.

[5] Wu Haiyan, Wang Suju, Gao Zhiqiang, et al.
Preliminary analysis of central paroxysmal positional vertigo [J].
Chinese Journal of Otolaryngology Head and Neck Surgery, 2020, 55 (08): 754-759.
DOI: 10.
3760/cma.
j.
cn115330-20200616-00504

[5] Wu Haiyan, Wang Suju, Gao Zhiqiang, et al.
Preliminary analysis of central paroxysmal positional vertigo [J].
Chinese Journal of Otolaryngology Head and Neck Surgery, 2020, 55 (08): 754-759.
DOI: 10.
3760/cma.
j.
cn115330-20200616-00504 Leave a message here