ABSTRACT
A 50-year-old woman wakes in the middle of the night complaining of a spinning sensation with nausea that lasts for about 30 seconds. The symptoms are most obvious turning over onto the right side.
E This woman has BPPV. The pathophysiology is under much debate, but detachment of calcium carbonate crystals (otoliths) that become detached from the utricle and saccule is perceived to be the likely pathology. The otoliths migrate to the posterior semicircular canal and stimulate the vestibular nerve on specific head movements. This causes a rotatory nystagmus. The diagnosis is confirmed with a positive Hallpike Dix manoeuvre.
