Disabling Positional Vertigo

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Abstract
We have identified a group of patients with vestibular disorders whose symptoms are not consistent with the commonly recognized syndromes such as Meniere's disease, benign paroxysmal positional vertigo, and vestibular neuronitis. These patients have a constant positional vertigo and are often nauseated to an extent that makes them disabled. Their symptoms do not respond to conventional medical treatment or habituating therapy. We have found specific clinical-pathological signs in these patients that indicate that the vestibular nerve is compressed intracranially by blood vessels. Treatment of nine such patients by microvascular decompression of the eighth nerve brought total relief of symptoms in eight patients and improvement in one. We suggest that this syndrome be named disabling positional vertigo. (N Engl J Med 1984; 310:1700–5.)