Benign Paroxysmal Positional Vertigo vs Vestibular Neuritis and Labyrinthitis
Benign Paroxysmal Positional Vertigo and Vestibular Neuritis and Labyrinthitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Benign Paroxysmal Positional Vertigo vs Vestibular Neuritis and Labyrinthitis at a glance
- Benign Paroxysmal Positional Vertigo: Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning.
- Vestibular Neuritis and Labyrinthitis: Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo.
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Side-by-side comparison
| Feature | Benign Paroxysmal Positional Vertigo | Vestibular Neuritis and Labyrinthitis |
|---|---|---|
| At a glance | Brief positional vertigo from displaced otoconia in a semicircular canal; treat with canalith repositioning. | Acute peripheral vestibulopathy from inflammation of the vestibular nerve (neuritis) or whole inner ear (labyrinthitis), producing prolonged vertigo. |
| Classic presentation | Dix-Hallpike maneuver provoking transient upbeat-torsional nystagmus with concurrent vertigo, latency, and fatigability.; Brief (<60 seconds) episodes of true… | AVS with peripheral HINTS pattern + recent URI + unidirectional nystagmus suppressed by fixation.; Sudden severe constant vertigo lasting hours to days, often… |
| Workup / key labs | Bárány Society criteria: characteristic positional vertigo + positional nystagmus on appropriate maneuver (Dix-Hallpike for posterior canal, head-roll for… | Bárány Society 2022: acute or subacute onset of spinning vertigo, lasting at least 24 h, with spontaneous horizontal nystagmus and unilateral vestibular… |
| Imaging | Imaging NOT required for classic BPPV; MRI brain with brainstem/IAC views if: atypical features (continuous vertigo, neurologic findings, central nystagmus,… | HINTS exam at bedside is more sensitive than early MRI for posterior stroke in AVS; MRI brain with DWI within 24-72 h if any central features, vascular risk… |
| First-line treatment | Canalith repositioning maneuvers — definitive treatment:; Epley maneuver for posterior canal BPPV (success rate 60-90% per attempt; may repeat); Semont… | Acute symptomatic relief (24-72 h only, then taper): meclizine 25-50 mg q6-8h, dimenhydrinate, promethazine, lorazepam, ondansetron; Hydration — IV fluids if… |
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