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Benign Paroxysmal Positional Vertigo is Sometimes Not so Benign
  1. Heinrich P. Mattle
  1. Professor of Neurology, Department of Neurology, Inselspital, 3010 Bern, Switzerland; E-mail: heinrich.mattle{at}


Volker Henn, Günter Baumgartner and Felix Jerusalem, my teachers at medical school and during my first year of neurology residency in Zurich in 1978, taught me about the approach to and examination of the ‘dizzy patient’. They taught me that some types of vertigo occur only in certain positions of the head or body, or during certain changes of position, and that examination of a dizzy patient is never complete without having performed the Hallpike manoeuvre (Fig. 1), best with Frenzel goggles (glasses consisting of + 30 lenses mounted in a frame that contains a light source so the patient’s eyes are easily seen by the examiner and also the patient cannot focus his eyes on an object that abolishes visual suppression of nystagmus). I eagerly read many articles about positioning vertigo, mostly referred to as ‘benign positional vertigo’ – a shift of position provokes vertigo and transient nystagmus. Typically, in

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