Dizziness is a common symptom that most people experience at some point in their lives. It can take many forms — a sudden sensation that the room is spinning, a tendency to veer to one side while walking, or a foggy-headed feeling that makes it hard to keep one's balance. When dizziness strikes, many people immediately suspect benign paroxysmal positional vertigo, commonly known as BPPV. In practice, however, a wide range of conditions can be the cause, making precise differential diagnosis essential.
Dizziness can stem from problems with the vestibular organs in the inner ear, but also from cerebrovascular disease, autonomic nervous system dysfunction, and psychological factors. Identifying the cause therefore requires a comprehensive assessment of the circumstances in which dizziness occurs, how long it lasts, and what other symptoms accompany it.
BPPV — one of the most common causes of dizziness — is formally known as benign paroxysmal positional vertigo. It occurs when calcium carbonate crystals, called otoliths, dislodge from their normal position in the vestibular organ and migrate into the semicircular canals. The condition typically produces sudden rotational dizziness when getting out of bed in the morning, rolling over while lying down, or tilting the head back.
Classic BPPV is characterized by brief episodes of dizziness lasting from a few seconds to under a minute, triggered by specific head positions. However, the pattern and duration of symptoms can vary depending on which semicircular canal the crystals have entered and how they move, making careful clinical examination necessary.
Nystagmus — involuntary, repetitive eye movements — is one of the key diagnostic clues in BPPV. It plays an important role in distinguishing the cause of dizziness. Neurologists analyze the direction, duration, and pattern of nystagmus through positional testing and other examinations, using those findings to determine the type of BPPV and the appropriate course of treatment.
The standard treatment for BPPV is a canalith repositioning procedure, which moves the displaced crystals back to their original location through a series of carefully sequenced head and body positions. The Epley maneuver is the best-known example, but not every BPPV patient can be treated with the same technique — the right approach depends on which canal is affected and how the crystals are moving. Repeatedly performing postural exercises based on online videos without an accurate diagnosis can reduce treatment effectiveness or even worsen symptoms. If dizziness persists after treatment, it is important to determine whether the remaining symptoms are residual effects of BPPV or whether another vestibular disorder is also present.
Among the conditions that must always be considered when evaluating dizziness, stroke deserves particular attention. Cerebral infarction affecting the cerebellum or brainstem can present with dizziness as a primary symptom. In some patients, severe dizziness and difficulty walking may occur without obvious paralysis or speech impairment.
BPPV typically causes brief, recurring episodes of dizziness triggered by specific head movements, whereas stroke-related dizziness tends to come on suddenly and persist. These characteristics alone, however, are not always sufficient to distinguish between the two conditions. If sudden dizziness is accompanied by weakness in one arm or leg, slurred speech, double vision, or difficulty standing or walking independently, the patient should go to an emergency room immediately.
A range of other neurological and vestibular disorders — including vestibular migraine, vestibular neuritis, and persistent postural-perceptual dizziness — can also cause dizziness. Because symptoms and treatment vary depending on the underlying condition, anyone experiencing recurring or prolonged episodes is advised to consult a specialist to identify the precise cause.
"What matters most in treating dizziness is not simply relieving symptoms temporarily, but accurately identifying the underlying condition," said Kim Min-gu, director of Gyeongil Neurology Clinic and a specialist in neurology. "Even when the symptom is the same, the treatment approach and prognosis can differ depending on the cause, so a treatment plan tailored to each patient must be built on thorough medical history-taking, neurological examination, and nystagmus testing."
kty@heraldcorp.com
