Abstract
Background: Dizziness is one of the most common symptoms encountered in neurological practice. It has a wide range of etiologies, among which benign paroxysmal positional vertigo (BPPV) is the most frequent. The diagnosis of BPPV is primarily based on clinical history and bedside positional tests, particularly the Dix–Hallpike maneuver. Treatment mainly consists of canalith repositioning maneuvers (CRMs) because vertiginous symptoms are caused by displaced otoconia migrating into the endolymph of the semicircular canals—most commonly the posterior semicircular canal—resulting in asymmetric vestibular input during head movements. In most patients, BPPV can be managed effectively with simple repositioning maneuvers. However, treatment may be challenging in certain clinical situations. Challenges in the management of BPPV: Difficulties may arise from establishing an accurate diagnosis, identifying the affected semicircular canal, managing patients with severe vertigo who are unable to tolerate repositioning maneuvers, persistent symptoms despite successful canalith repositioning, the development of anxiety-related symptoms following treatment, and other clinical complexities. Conclusion: Overcoming these challenges requires an appropriate diagnostic and therapeutic strategy tailored to the individual patient. In addition to effective acute management, long-term follow-up and periodic reassessment are essential to optimize recovery, reduce recurrence, and improve patients' quality of life.
