Benign paroxysmal vertigo of childhood

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By Paul Winner DO

Benign paroxysmal vertigo is a disorder of childhood that consists of recurrent attacks of sudden vertigo that are maximal at onset. Ataxia may be present, but it is rare. The vertigo is so severe that standing may be impossible. The child looks frightened. A transient decrease in vestibular function may be noticed, but consciousness is maintained through the event. Headache is not usually part of the clinical picture. The attacks may last a few minutes and in extreme cases hours to 2 days. In this clinical article, Dr. Paul Winner of the Palm Beach Headache Center explains the clinical manifestations, why caution must be exercised to exclude the differential diagnoses, the appropriate recommended workup, and important treatment options.

Key Points

  • Benign paroxysmal vertigo occurs in young children and consists of abrupt episodes of unsteadiness or ataxia. Benign paroxysmal vertigo is a frequent etiology of childhood dizziness.
  • The child may appear startled or frightened by the sudden loss of balance, which is accompanied by brief nystagmus and/or pallor; consciousness is always preserved.
  • The diagnosis of benign paroxysmal vertigo is based on the clinical history, but the differential includes posterior fossa tumors or cervical spine abnormalities, otological pathology, epilepsy (benign occipital epilepsy), or metabolic disorders.