[Benign paroxysmal positional vertigo: clinical aspects and medico-legal considerations]

Benign paroxysmal positional vertigo (BPPV) is quite frequently found as an otological consequence of cranial traumas; thus leading to medico-legal implications. An attempt has herewith been made to evaluate these implications on the basis of data available. Therefore, 158 patients suffering from BPPV were examined between 1984-1986. Of these 23% of the total were post-traumatic forms (of medico-legal interest). Among patients suffering from post-traumatic vestibular disturbances in the broad sense, the incidence of BPPV proved to be greater in the ages ranging from 50 to 70. In those under 30 years of age BPPV was hardly ever present (5% of the total) although when it was its origin was always post-traumatic. The temporal evolution of paroxysmal positional vertigo, which tends to spontaneously disappear, is paralleled in BPPV patients whether it is of post-traumatic origin or not. On the other hand, the subjective sensation of positional vertigo takes longer to clear up in post-traumatic BPPV patients, most likely due to factors stemming from the so-called "compensation syndrome". Any medico-legal evaluation of BPPV must, therefore, take into account its natural favorable evolution. This makes it necessary to examine the patient several times over a period of at least six months from the moment of trauma. In medico-legal terms, the features of BPPV (i.e. position setting it off, duration of vertigo, frequency with which it appears when that position is assumed, presence and duration of the positional nystagmus) lead to inability to work in from 2 to 10% of the cases.