Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- posições de provocação específicas
- duração rápida da vertigem
- vertigem episódica
- episódios intensos de vertigem
- início súbito de vertigem
- náuseas, desequilíbrio e tontura
- ausência de sintomas neurológicos ou otológicos associados
- exame neurológico normal
- manobra de Dix-Hallpike positiva ou rotação de cabeça lateral supina positiva
- exame otológico normal
Outros fatores diagnósticos
- idade >50 anos
- sexo feminino
- vertigem posicional na ausência de nistagmo
Fatores de risco
- idade mais avançada
- sexo feminino
- trauma cranioencefálico
- neurite vestibular
- labirintite
- enxaquecas
- cirurgia da orelha interna
- Doença de Ménière
- otite média
- hipertensão
- hiperlipidemia
- diabetes mellitus
- insuficiência vertebrobasilar
- arterite de células gigantes
- osteoporose
- intubação
- posicionamento lateral de cabeça habitual durante o repouso no leito (VPPB ipsilateral)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Manobra de Dix-Hallpike
- rotações de cabeça lateral na posição supina
Investigações a serem consideradas
- audiograma
- ressonância nuclear magnética (RNM) cranioencefálica
Algoritmo de tratamento
apresentação inicial
manobras de reposicionamento múltiplas e exercícios de reabilitação vestibular inefetivos
Colaboradores
Autores
Lorne S. Parnes, MD, FRCSC
Professor
Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences
University of Western Ontario
London
Canada
Declarações
LSP is an author of a number of references cited in this topic.
Shahin Nabi, MD, FRCSC
Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences
University of Western Ontario
London
Canada
Declarações
SN declares that he has no competing interests.
Revisores
Joel Goebel, MD, FACS
Professor and Vice Chairman
Residency Program Director
Dizziness and Balance Center Director
Otolaryngology-Head and Neck Surgery
Washington University School of Medicine
St. Louis
MO
Disclosures
JG is an author of a number of references cited in this topic.
Stephen P. Cass, MD
Associate Professor
Department of Otolaryngology
University of Colorado
Aurora
CO
Disclosures
SPC is an author of a number of references cited in this topic.
Steven D. Rauch, MD
Associate Professor of Otology and Laryngology
Harvard Medical School
Boston
MA
Disclosures
SDR declares that he has no competing interests.
Malcolm Hilton, BA, BMBCh, FRCS (Eng), FRCS (ORL-HNS)
Consultant Otolaryngologist & Honorary Lecturer
Royal Devon & Exeter NHS Foundation Trust
Exeter
UK
Disclosures
MH is the author of one reference cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014 Dec 8;(12):CD003162.Full text Abstract
Leveque M, Labrousse M, Seidermann L, et al. Surgical therapy in intractable benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2007 May;136(5):693-8. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Doença de Ménière
- Neuronite vestibular
- Labirintite
More DifferentialsGuidelines
- ACR appropriateness criteria: dizziness and ataxia
- Clinical practice guideline: benign paroxysmal positional vertigo (update)
More GuidelinesPatient information
Vertigem posicional paroxística benigna
More Patient information
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