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Related Experiment Video

Updated: Mar 25, 2026

Assessment of Static Graviceptive Perception in the Roll-Plane using the Subjective Visual Vertical Paradigm

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Differentiating Atypical BPPV from Central Positional Vertigo: A Narrative Review.

Giorgos Sideris¹, George Korres¹, Ilias Lazarou¹

¹2nd Ear Nose Throat Department, Attikon University Hospital, 124 62 Athens, Greece.

|March 24, 2026

Summary

This summary is machine-generated.

Atypical benign paroxysmal positional vertigo (BPPV) presents with unusual symptoms, complicating diagnosis. Careful assessment of nystagmus and exclusion of red flags are key for accurate identification and management of this vestibular disorder.

Keywords:

BPPV atypical BPPV central positional nystagmus cerebellar dysfunction positional vertigo vestibular positional testing

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Area of Science:

Neurology
Otolaryngology
Vestibular Disorders

Background:

Typical benign paroxysmal positional vertigo (BPPV) has characteristic presentations during positional testing.
Atypical BPPV variants present with non-standard patterns, increasing diagnostic complexity and risk of misdiagnosis.

Purpose of the Study:

To delineate the clinical spectrum of atypical BPPV.
To differentiate atypical BPPV from central positional vertigo.
To offer practical diagnostic guidance for clinicians managing positional vertigo.

Main Methods:

A narrative review of existing literature on atypical BPPV was conducted.
Clinical presentations, diagnostic challenges, and differentiation from central causes were explored.

Main Results:

Atypical BPPV can manifest as vertigo without nystagmus, conflicting torsional nystagmus, or persistent symptoms post-maneuver.
Variants like canal switch and pseudo-spontaneous nystagmus were identified.
Absence of neurological signs aids in distinguishing peripheral atypical BPPV from central etiologies.

Conclusions:

Accurate diagnosis of atypical BPPV requires meticulous bedside assessment of nystagmus characteristics and exclusion of red flags.
Understanding atypical BPPV variants is crucial for timely and effective treatment.
Neuroimaging is recommended when BPPV resolution is lacking or central pathology is suspected.