Benign paroxysmal vertigo of childhood

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By Stephanie Wrobel Goldberg MD

Benign paroxysmal vertigo was previously described under the childhood periodic syndromes spectrum, which also included cyclical vomiting, abdominal migraine, and benign periodic torticollis. The most updated version of the International Classification of Headache Disorders (ICHD-3 beta version) has replaced the term ‘‘periodic symptoms’’ with ‘‘episodic symptoms which are associated with migraine’’ (1.6), and the term is no longer limited to the childhood population.

This disorder consists of recurrent attacks (at least 5) of severe sudden vertigo that resolve spontaneously. At least 1 of the following including nystagmus, ataxia, vomiting, pallor, and/or fearfulness should be present, and consciousness is maintained through the event. Neurologic examination and vestibular and audiometric functions are all normal between attacks, as are imaging studies and electroencephalography. The attacks may last minutes to hours and in extreme cases as long as 2 days. In this article, the author 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 may occur in up to 2.6% of 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), and vestibular and metabolic disorders.
  • According to the most recent ICHD-3 beta edition, this disorder should have at least 1 of the following symptoms or signs: nystagmus, ataxia, vomiting, pallor, fearfulness.

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited