Strategies to Distinguish Benign Paroxysmal Positional Vertigo from Rotational Vertebrobasilar Ischemia

Vertigo provoked by head rotation is a classic symptom of rotational vertebrobasilar ischemia (RVBI). Inner ear disease can cause positional vertigo and mimic RVBI. We review the case of a patient with vertigo consistently triggered by leftward head rotation when supine. Computed tomography angiogram and dynamic arteriogram failed to show compression of the vertebral arteries with head rotation. Further evaluation revealed benign paroxysmal positional vertigo (BPPV) as the underlying etiology. Treatment of her BPPV led to complete resolution of her symptoms. A succinct overview of this common otologic disorder is provided, and strategies to help distinguish it from RVBI are discussed.