Also known as BENIGN CERVICOGENIC VERTIGO, produces symptoms consisting of momentary vertigo, sometimes only dysequilibrium, provoked by head extension and turning, sometimes ONLY in one direction!
The maneuver illustrated below, called Nylen-Barany or Hallpike Dix, is virtually diagnostic if visible nystagmus (involuntary jerking of the eyes is provoked, usually after a few seconds latency.
Positional vertigo can be frightening and raise concerns about impending stroke although vertigo alone, due to brainstem stroke or ischemia, is rare and BPV, by contrast, very common.
In younger patients the inner ear may be the cause and if ear pain, fullness, hearing loss or tinnitus are present an Ear Nose and Throat specialist should definitely be consulted. But in older patients, with a history of neck stiffness or pressure type tension headache behind both eyes in the morning; with negative review of systems for other cranial nerve or neurologic symptoms and the physical examination normal other than other than reduced range of neck motion and tenderness of the neck muscles, the neglected neck is suspect number one.
Medications for dizziness such as ANTIVERT may help but are often unsatisfactory and/or poorly tolerated. Massage with manual neck traction can be curative. Daily cervical range of motion is a good idea.
Endarterectomies for dizziness alone aren't indicated.
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