A-Typical BPPV Flashcards
What is Atypical BPPV?
Atypical BPPV involves the less commonly affected semicircular canals: anterior and horizontal canals.
What are the three semicircular canals involved in BPPV?
The posterior, anterior, and horizontal semicircular canals.
Which semicircular canal is most commonly affected in BPPV?
The posterior semicircular canal.
Which tests are recommended for diagnosing anterior canal BPPV?
Dix-Hallpike or Deep Head Hanging Test.
What type of nystagmus is seen in anterior canal BPPV during the Dix-Hallpike test?
Downbeating and torsional nystagmus.
What are the common treatment maneuvers for anterior canal BPPV?
Epley, Reverse Semont, and other possible maneuvers (though not covered in this course).
Which semicircular canal is the second most common site for BPPV?
The horizontal semicircular canal.
What type of nystagmus is associated with horizontal canal BPPV?
Horizontal nystagmus.
What symptoms are typical of horizontal canal BPPV?
Symptoms are similar to posterior canal BPPV but may not be described as ‘spinning.’ Symptoms may occur with rolling in bed or turning the head to both sides.
What is the recommended test if Dix-Hallpike is negative but BPPV is still suspected?
The Supine Roll Test.
How is the Supine Roll Test performed?
The patient’s head is turned 90° to each side while lying supine with 20° cervical flexion, holding each position for 30-60 seconds to check for nystagmus and vertigo.
What indicates a positive result for horizontal canal BPPV in the Supine Roll Test?
Vertigo and nystagmus are present when the head is turned to both sides, with stronger responses on one side.
What are the two conditions that need to be differentiated in horizontal canal BPPV?
Canalithiasis and cupulolithiasis.
What type of nystagmus is indicative of canalithiasis in horizontal canal BPPV?
Geotropic nystagmus (beating toward the ground).
What is the typical duration of nystagmus in geotropic horizontal canal BPPV?
Less than 1 minute.
What type of nystagmus is indicative of cupulolithiasis in horizontal canal BPPV?
Apogeotropic nystagmus (beating away from the ground).
What is the typical duration of nystagmus in apogeotropic horizontal canal BPPV?
More than 1 minute.
How can the affected ear be determined in horizontal canal BPPV?
In geotropic nystagmus (canalithiasis), the stronger nystagmus indicates the affected ear. In apogeotropic nystagmus (cupulolithiasis), the weaker nystagmus indicates the affected ear.
What is the BBQ maneuver?
A 270° roll in the plane of the horizontal canal, ending in the prone position.
For which type of horizontal canal BPPV is the BBQ maneuver most effective?
Geotropic (canalithiasis) but can be used for both forms.
What should be considered if BPPV does not improve after 3-5 visits?
Consider referring to a specialist or further investigating the cause.
What patient education is recommended following a BPPV treatment session?
Advise the patient to take it easy the day of treatment and avoid excessive bending or lying flat. Return to normal activities afterward with free head movements.
What is the characteristic nystagmus direction in geotropic horizontal canal BPPV?
Nystagmus beats toward the ground.
What is the characteristic nystagmus direction in apogeotropic horizontal canal BPPV?
Nystagmus beats away from the ground.
How does the intensity of nystagmus help in identifying the affected ear in canalithiasis?
Stronger nystagmus and vertigo on the affected side.
How does the intensity of nystagmus help in identifying the affected ear in cupulolithiasis?
Weaker nystagmus and vertigo on the affected side.
Why is it often difficult to determine the affected ear in horizontal canal BPPV?
Because nystagmus and vertigo are present when turning to both sides.
What does the term ‘geotropic’ mean in the context of BPPV?
Geotropic means ‘toward the earth,’ indicating nystagmus beating toward the ground.
What does the term ‘apogeotropic’ mean in the context of BPPV?
Apogeotropic means ‘away from the earth,’ indicating nystagmus beating away from the ground.
