Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus

Béla Büki, László Simon, Sándor Garab, Yunxia W. Lundberg, Heinz Jünger, Dominik Straumann

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Background: Presently, the unambiguous diagnosis of benign paroxysmal positioning vertigo (BPPV) requires the detection of positioning or positional nystagmus provoked by DixeHallpike (for vertical semicircular canals) or supine roll (for horizontal semicircular canals) manoeuvres, which indicates canalo- or cupolithiasis of affected semicircular canals. There are patients, however, in whomddespite typical complaints of BPPVdno positional nystagmus can be documented; this is called 'subjective BPPV' (sBPPV). These patients usually complain of short vertigo spells during and after sitting up, sometimes with abnormal retropulsion of the trunk. Aim: In this study, the authors aimed to ascertain whether these patients in fact demonstrate abnormal sitting-up trunk oscillations when measured by posturography. Of 200 unselected patients with vertigo or dizziness, 43% had sBPPV with vertigo spells while sitting up, and 20% classical BPPV. Methods: Posturographic recordings were performed in 20 patients with sBPPV and sitting-up vertigo. Results and discussion: Seven of the 20 patients had trunk oscillations during the act of sitting up and for a short time immediately afterwards. Based on their findings, the authors propose a new type of BPPV, the so-called Type 2 BPPV (typical complaints of BPPV, no nystagmus in DixeHallpike positions but short vertigo spell while sitting up), which may be the result of chronic canalolithiasis within the short arm of a posterior canal. Furthermore, the authors suggest that Type 2 BPPV, which could be identical to sBPPV or constitute a major subgroup of it, occurs frequently among patients with vertigo. For therapy, the authors recommend repetitive sit-ups from the DixeHallpike positions to liberate the short arm of the posterior canal from canaloliths.

Original languageEnglish (US)
Pages (from-to)98-104
Number of pages7
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number1
StatePublished - Jan 2011

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health


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