Benign Paroxysmal Positional Vertigo

Question 1

Define Benign Paroxysmal Positional Vertigo

Answer 1

Peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo and head movements

Question 2

Aetiology of Benign Paroxysmal Positional Vertigo

Answer 2

Primary: idiopathic (50-70%)

Secondary:
○ Head trauma
○ Labyrinthitis
○ Migraines
○ Vestibular neuronitis
○ Meniere's disease
○ Ischaemic processes
○ Iatrogenic causes

Question 3

Risk factors for Benign Paroxysmal Positional Vertigo

Answer 3

Older age
Female sex
Head trauma
Vestibular neuronitis
Labyrinthitis 
Migraines
Inner ear surgery 
Meniere's disease
Otitis media 
HTN, hyperlipidaemia, diabetes
Temporal arteritis

Question 4

Symptoms of Benign Paroxysmal Positional Vertigo

Answer 4

Vertigo (Environmental spinning)
○ Sudden onset 
○ Brief duration
○ Episodic 
○ Specific provoking positions e.g. household chores like hanging washing
Nausea, imbalance and lightheadedness

Question 5

Signs of Benign Paroxysmal Positional Vertigo on examiantion

Answer 5

Normal neurological exam

Question 6

Investigations for Benign Paroxysmal Positional Vertigo

Answer 6

Dix-Hallpike manoeuvre: Vertigo with the appropriate position-provoked nystagmus response (occur within 1-5s of latency and lasts <30s)

Supine lateral head turns: Horizontal nystagmus without a torsional (rotatory) component

Audiogram if there is hearing loss: normal in primary
MRI: ?central condition mimicking BPPV

Question 7

What is the Dix-Hallpike manoeuvre

Answer 7

The patient is seated and positioned on an examination table such that the patient’s shoulders will come to rest on the top edge of the table when supine, with the head and neck extending over the edge.
The patient’s head is turned 45° towards the ear being tested.
The head is supported, and then the patient is quickly lowered into the supine position with the head extending about 30° below the horizontal while remaining turned 45° towards the ear being tested.

The head is held in this position and the physician checks for nystagmus.
To complete the manoeuvre, the patient is returned to a seated position and the eyes are again observed for reversal nystagmus.

Nystagmus is torsional (rotatory) in nature, reversible with sitting, and fatiguable with repeat testing and unilateral