Positional vertigo: central and benign paroxysmal positional vertigo

The basis of positional vertigo is usually benign paroxysmal positional vertigo (BPPV) associated with damage to the semicircular canals of the vestibular analyzer. The diagnosis of BPPV is based on positional tests that help to determine the affected canal. Central positional vertigo is characterized by nystagmus which, unlike nystagmus in BPPV, does not subside in most cases, has no rotational component and no latency period. Two clinical observations of patients with central positional vertigo caused by a brain tumor and ischemic stroke are presented. The differential diagnosis of BPPV and central positional vertigo and the treatment of acute vestibular vertigo are discussed. The data on the efficacy and safety of the use of a fixed combination of dimenhydrinate and cinnarizine (Arlevert) for the treatment of acute vestibular vertigo are analyzed.