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Vertigem posicional paroxística benigna

Last reviewed: 20 Aug 2025
Last updated: 28 Sep 2021

Summary

Definition

History and exam

Key diagnostic factors

  • 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
Full details

Other diagnostic factors

  • idade >50 anos
  • sexo feminino
  • vertigem posicional na ausência de nistagmo
Full details

Risk factors

  • 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)
Full details

Diagnostic investigations

1st investigations to order

  • Manobra de Dix-Hallpike
  • rotações de cabeça lateral na posição supina
Full details

Investigations to consider

  • audiograma
  • ressonância nuclear magnética (RNM) cranioencefálica
Full details

Treatment algorithm

ACUTE

apresentação inicial

ONGOING

manobras de reposicionamento múltiplas e exercícios de reabilitação vestibular inefetivos

Contributors

Authors

Lorne S. Parnes, MD, FRCSC
Lorne S. Parnes

Professor

Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences

University of Western Ontario

London

Canada

Disclosures

LSP is an author of a number of references cited in this topic.

Shahin Nabi, MD, FRCSC
Shahin Nabi

Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences

University of Western Ontario

London

Canada

Disclosures

SN declares that he has no competing interests.

Peer reviewers

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
  • Vertigem posicional paroxística benigna images
  • Differentials

    • Doença de Ménière
    • Neuronite vestibular
    • Labirintite
    More Differentials
  • გაიდლაინები

    • ACR appropriateness criteria: dizziness and ataxia
    • Clinical practice guideline: benign paroxysmal positional vertigo (update)
    More გაიდლაინები
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