Positional vertigo is triggered by and occurs after a change of head position in space relative to gravity. The most common cause is benign paroxysmal positional vertigo, which can be effectively cured with positioning maneuvers. The differentiation from central positional vertigo is discussed by Dr. Michael von Brevern and Dr. Thomas Lempert of Charité, Berlin. This summary includes a rare differential diagnosis to positional vertigo: rotational vertebral artery syndrome. In rotational vertebral artery syndrome, vertigo is not induced by positional maneuvers but by rotation of the head to one side. Recent studies with eye movement recordings support the view that ischemia of the labyrinth leading to transient excitation of vestibular hair cells is the cause of rotational vertebral artery syndrome.
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