Benign paroxysmal vertigo of childhood

Benign paroxysmal vertigo of childhood (BPVC for short) is a medical problem that happens in children.  "Benign" means "harmless;" "paroxysmal" means something comes and goes suddenly; and "vertigo" means "dizziness."  So BPVC is harmless dizziness in children that comes and goes suddenly.

The dizziness usually makes children feel like they are moving or spinning, or that the inside of their head is moving or spinning.

Usually, BPVC starts in children between two and five years old.  It often goes away by the age of eight.  But in some children, BPVC may start when they are much younger (as young as a few months old) or older (as old as 12 years old). 

BPVC is the most common cause of dizziness in children who do not have hearing loss or a diagnosed ear disease.  It is a common problem that happens to about 2.6% of children (26 out of 1,000 children).
Causes
Doctors don't know for sure what causes BPVC.  Some doctors think it is related to problems of the inner ear that affect balance.Thomas Brand: Vertigo: Its Multisensory Syndromes p.336 (Springer) 2003  For example, some doctors think BPVC is similar to a different disorder which often happens in adults over 50.  This disorder is called benign paroxysmal positional vertigo (BPPV).  BPPV is a "vestibular disorder" - a disorder in the inner ear which affects balance. 

Other doctors believe BPVC is related to migraine headaches, but most children with BPVC do not get headaches.Michael C. Brodsk: Pediatric Neuro-Ophthalmology p.218 (Springer, 2010)

Signs and symptoms

[[Image:Optokinetic nystagmus.gif|left|thumb|Horizontal (side to side) optokinetic nystagmus. The eyes may also move up and down (vertical optokinetic nystagmus).]]
Nystagmus (sometimes called "dancing eyes"): Fast, uncontrollable eye movements. These eye movements may happen on their own or be caused by staring.  When a child with BPVC is not having other symptoms, they may have positional nystagmus, which happens when the head is in a certain position.
Nausea: Feeling like throwing up.
Vomiting: Throwing up.
Gait ataxia: Problems walking because a medical problem (like BPVC) makes the muscles not work together.  This symptom may be harder to see in infants who cannot walk yet.
Postural imbalance: Having trouble staying balanced, which makes it hard to stand up straight.  This symptom may be harder to see in infants who cannot stand yet.
Looking scared: Children may look scared because of the physical symptoms that BPVC is causing, like loss of balance and dizziness.

 Diagnosis 
For a doctor to diagnose Benign Paroxysmal Vertigo of Childhood, all of these things must be true:The Headache Classification Subcommittee of the International Headache Society, 2004  
 The child has had at least five attacks of vertigo.
 The child gets vertigo a lot; the dizziness happens all of a sudden, and goes away after a few minutes to a few hours.
 The child had a normal neurological examination (which tests whether there are problems with how the brain is working)
 The child had normal audiometric and vestibular functions between attacks (this means that between attacks, the child had normal hearing, and there were no obvious problems with the inner ears)
 The child had normal electroencephalography (EEG) (this is a test that looks for unusual electrical activity in the brain).
Differential diagnosesDifferential diagnoses'' are different medical disorders which may cause the same symptoms.  When a doctor asks what the differential diagnoses for BPVC are, she is asking "what other disease could cause these symptoms?  What else could this be?"  Before a doctor makes a final diagnosis, they must think of what other medical conditions have the same or similar symptoms, and make sure one of them is not the problem.

Some of the differential diagnoses for BPVC are:
 Posterior fossa tumor: A tumor in the part of the brain that is in or near the bottom of the skull. Posterior fossa tumors happen more in children than they do in adults.  About 54%-70% of all brain tumors that children get start in the posterior fossa.
 Cervical spine abnormalities: Problems with the part of the spine in the neck.
 Otological disorders: Problems with the insides of the ears.
 Benign occipital epilepsy: A kind of epilepsy that most children outgrow.
 Metabolic disorders: Problems with the way the body makes energy from food.

References

Category:Migraine
Category:Health problems
Category:Children