Review Article

Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus

Table 1

Diagnosis of the involved semicircular canal and the side of involvement, according to the appropriate diagnostic maneuver. SC: semicircular canal; R: right; L: left; P: posterior; A: anterior; H: horizontal; BPPV: benign paroxysmal positional vertigo.
(a) Vertical SC canals

Involved SC canalDiagnostic maneuverParoxysmal positioning nystagmus
VerticalTorsional

P-BPPV RDix-Hallpike R (+)UpbeatingCounterclockwise
Dix-Hallpike L (−)No nystagmus

P-BPPV LDix-Hallpike R (−)No nystagmus
Dix-Hallpike L (+)UpbeatingClockwise

A-BPPV RDix-Hallpike R (+)DownbeatingCounterclockwise
Dix-Hallpike L (+)DownbeatingCounterclockwise

A-BPPV LDix-Hallpike R (+)Downbeatingclockwise
Dix-Hallpike L (+)DownbeatingClockwise

(b) Horizontal SC canals

Direction of nystagmusIntensity of nystagmusPathogenetic mechanism

H-BPPV RSupine roll test R (+)GeotropicMore intenseCanalolithiasis
Supine roll test L (+)GeotropicLess intense

H-BPPV RSupine roll test R (+)ApogeotropicLess intenseCupulolithiasis or canalolithiasis of the short arm of the horizontal SC
Supine roll test L (+)ApogeotropicMore intense

H-BPPV LSupine roll test R (+)GeotropicLess intenseCanalolithiasis
Supine roll test L (+)GeotropicMore intense

H-BPPV LSupine roll test R (+)ApogeotropicMore intenseCupulolithiasis or canalolithiasis of the short arm of the horizontal
Supine roll test L (+)ApogeotropicLess intense