At MHMC Flashcards
What movements are likely to provoke and attach of vertigo in BPPV?
The most common provocative movements are:
rolling over in bed
bending over (eg to tie shoelaces)
looking upward (eg putting something on shelf)
What is benign positional paroxysmal vertigo?
Benign paroxysmal positional vertigo (BPPV) is a disorder characterized by brief (<1 min) recurrent attacks of vertigo provoked by certain changes in head position with respect to gravity (1).
Apart from vertigo, are there any other symptoms in BPPV?
Nausea is common but vomiting is rare.
Lightheadedness and imbalance also may be associated.
Presence of hearing loss, tinnitus, or feeling of fullness of the ears indicates another diagnosis.
How long does BPPV last?
Usually self limiting, though may be present from weeks to years.
How is diagnosis of BPPV confirmed?
the diagnosis of posterior BPPV is confirmed by performing the Hallpike manoeuvre
a positive test may be seen in around 50% of patients at presentation
helps in confirming the diagnosis of BPPV, localising the affected side and to demonstrate canalith mobility
How do you perform a Dix-Hallpike test?
Inform patient might provoke vertigo/nausea
Sit patient on couch, read to lay down.
Rotate head 45 degrees to one side (side being tested).
Lay patient down in slight hyperextension, holding head and looking at eyes.
After 20-40 seconds, nystagmus present if BPPV.
Sit patient back up, get reverse nystagmus.
Check other side.
How is the Dix-Hallpike test interpreted?
Horizontal nystagmus after a two- to 20-second latent period suggests a peripheral vestibular cause e.g. benign paroxysmal positional vertigo (BPPV).
Vertical nystagmus without a latent period:
suggests a central vestibular cause
e.g., posterior fossa tumour.
How is BPPV treated?
1) watchful waiting - often self limiting within 6 months.
2) vestibular sedatives/anti emetics - the symptoms of an acute vestibular episode can be treated with either an anti-emetic (e.g. prochlorperazine or promethazine or cyclizine) or vestibular sedatives (e.g. the calcium channel antagonist cinnarizine (adult dose 30mg tds) or the histamine analogue betahistine) during the first days of the illness.
3) repositioning manoeuvres. (Eg, Epley)
4) surgery is possible but rarely done now.
contraindications to canalith repositioning procedures include:
severe carotid stenosis
unstable heart disease
severe neck disease (cervical spondylosis with myelopathy)
advanced rheumatoid arthritis
How is the Epley manoeuvre performed?
Epley’s manoeuvres consists of:
the Hallpike manoeuvre:
the patient is seated upright
the head is turned towards the affected side (say the left)
with the head still turned, the patient is reclined past the horizontal
hold for 30 seconds.
Then in the reclined position the head is turned to the right
hold for 30 seconds
the patient is rolled onto their right side
the head is still turned to the right (the patients is now looking towards the floor)
hold for 30 seconds
the patient is sat upright, still look over their right shoulder
hold for 30 seconds
the patient turns the head to the midline with the neck flexed, chin down through 45 degrees
hold for 30 seconds
