Peripheral Vestibular Labyrinthine Vertigo p

There is usually an acute, severe rotatory vertigo directed away from side of the labyrinthine lesion, with a tendency to fall toward the side of the lesion, horizontal nystagmus away from the side of lesion, nausea, and vomiting. Peripheral vestibular vertigo may depend on position, being triggered, for example, when the patient turns over in bed or stands up (positional ver-58 tigo), or it may be independent of position (persistent vertigo). It may also occur in attacks as episodic vertigo.

Positional vertigo. Benign, paroxysmal positional vertigo (BPPV) of peripheral origin is usually due to detached otoliths of the utricular macula floating in the posterior semicircular canal (canalolithiasis). With every bodily movement, the freely floating otoliths move within the canal, under the effect of gravity. An abnormal cupular deflection results, starting 1-5 seconds after movement and lasting up to 30 seconds. The Dix-Hallpike maneuver is a provocative test for BPPV: the patient is rapidly taken from a sitting to a supine position while the head is kept turned 45° to one side. If nystagmus and vertigo ensue, they are due to canalolithiasis on the side of the ear nearer the ground. The canalith repositioning procedure (CRP), by which particles can be removed from the semicircular canal, involves repeatedly turning the patient's head to the opposite side, then back upright. Episodic and persistent vertigo may be due to viral infection of the vestibular apparatus (vestibular neuritis, labyrinthitis) or to Meniere disease, which is characterized by attacks of rotatory vertigo, tinnitus, hearing loss, and ear pressure. Other causes include labyrinthine fistula and vestibular paroxysm.

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