A fifty-year-old man presents to his practitioner complaining that he often feels as if the room is spinning when he gets up from a recumbent position or turns his head. He has not lost consciousness and has had no chest pain. He has no cardiac history and a recent treadmill test showed no abnormalities. On examination, the sensation can be produced by rapidly turning the head. It can be reproduced many times, but it eventually ceases. Nystagmus is elicited. Hearing is normal. Which of the following is the most likely diagnosis?

Benign paroxysmal positional veigo (BPPV) is veigo that is precipitated by head position. It can be precipitated by trauma, but often no precipitating factor is identified. It generally abates after weeks to months. On exam, patients display nystagmus and the symptoms can be reproduced by head movement. In addition, the symptoms show latency, fatigability and habituation. Brain stem tumor and veebrobasilar TIA are causes of central causes of veigo, but would often be associated with other neurologic findings. Meniere disease displays the classic triad of unilateral tinnitus, unilateral deafness, and paroxysmal veigo. Since the patient has normal hearing, this is unlikely to be Meniere syndrome, although hearing loss may not manifest until later stages of the disease. Syncope is defined as transient loss of consciousness of cardiovascular origin. Thus since the patient has a lack of other cardiovascular symptoms and has not lost consciousness, this is not syncope.