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Diagnostic Criteria for Benign Paroxysmal Positional Vertigo

  • Vertigo associated with a characteristic mixed torsional and vertical nystagmus provoked by the Dix-Hallpike test

  • A latency (typically of 1 to 2 seconds) between the completion of the Dix-Hallpike test and the onset of vertigo and nystagmus

  • Paroxysmal nature of the provoked vertigo and nystagmus (i.e., an increase and then a decline over a period of 10 to 20 seconds)

  • Fatigability (i.e., a reduction in vertigo and nystagmus if the Dix-Hallpike test is repeated)


Common Causes of Vertigo

Otologic disorders

  • Benign paroxysmal positional vertigo

  • Meniere´s disease (hydrops endolymphayic)

  • Vestibular neuronitis (labyrinthitis)

Neurologic disorders

  • Migraine-associated dizziness

  • Vertebrobasilar insufficiency

  • Panic disorders


Dix-Hallpike Maneover for Positional Nystagmus



Peripheral disorder

Central disorder

Latent period before onset of positional nystagmus

2 to 20 seconds


Duration of nystagmus

Less than 1 minute

Greater than 1 minute


Fatiguing with repetition


Direction of nystagmus

Only one type, usually horizontal/rotatory

May change direction with a given head position

Intensity of vertigo


Less severe, sometimes none




Related Criteria:

Diagnostic Criteria for Meniere's Disease





  1. Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med. 1999 Nov 18;341(21):1590-6. [Medline]

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Created: Dic 23, 2005
Last Modified: 10/23/2010

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