Benign positional dizziness

General information. Benign positional dizziness is probably the most common vestibular disorder. Dizziness in this case appears only when moving or changing the position of the head, especially when it tilts back and forth. This condition often occurs when the patient rolls over from his back to one side and suddenly, with a certain position of his head, feels that “the room has gone.” Dizziness usually lasts a few seconds. Often patients know at what position of the head it occurs. Differences from positional vertigo of central genesis . Positional dizziness can occur with many other diseases, including damage to the brain stem (with multiple sclerosis, stroke or tumor). In order to distinguish benign positional dizziness from more dangerous diseases of the central nervous system, a Nilen-Barani test is performed . 

Etiology. Benign positional dizziness can occur after traumatic brain injury, viral disease, otitis media or stapedectomy , as well as with certain intoxications (e.g., alcohol and barbiturates). The course of the disease can be very different. In many cases, symptoms disappear on their own within a few weeks and then resume only after months or years. Sometimes a short-term attack occurs only once in a lifetime. Only occasionally positional dizziness persists for a long time. Treatment. For symptomatic therapy, the above funds are used, however, they are often ineffective. With a careful repetition of the movements that provoke dizziness, pathological reactions gradually “become exhausted.” Some believe that vestibular gymnastics, including provocative head movements, accelerates recovery. Patients are advised to hold their head for 30 seconds in a position that usually causes dizziness. This simple exercise, performed 5 times every few hours, in most cases brings improvement after a few weeks.

1. Acute post-traumatic dizziness. Vestibular dizziness, nausea, and vomiting can occur immediately after an injury due to the sudden shutdown of one of the labyrinths (shaking of the labyrinth). Less commonly, dizziness is caused by transverse or longitudinal fractures of the temporal bone, which are accompanied, respectively, by hemorrhage in the middle ear or damage to the eardrum with bleeding from the external auditory canal. The clinical picture. Dizziness is permanent. Spontaneous nystagmus with a slow phase directed towards the lesion, and imbalance with a tendency to fall in the same direction are characteristic. Symptoms intensify with sudden head movements. Treatment. Vestibulolytic agents often reduce the severity of symptoms. In the acute stage, scopolamine is most effective For long-term treatment, meclosin and dimenhydrinate are used . Usually spontaneous improvement occurs already in the first days. However, then it slows down, and most patients recover within 1-3 months. 

2. Post-traumatic positional dizziness . Within a few days or weeks after the injury, repeated short-term attacks of vestibular dizziness and nausea may occur, which are provoked by a movement of the head. The clinical picture is the same as with benign positional dizziness. Forecast. In most cases, spontaneous remission occurs within 2 months after the injury, and within 2 years – in almost all.

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