Benign Paroxysmal Positional Vertigo

Question 1

ESSENCE

Answer 1

Common cause of recurrent vertigo triggered by head movement, it is peripheral cause of vertigo as porblem is in inner ear rather than brain

Question 2

CLINICAL FEATURES

Presentation

Answer 2

• Specific provoking positions (if not related to movement central cause more likely)
• Brief duration of vertigo
• Episodic vertigo
• Sudden onset
• Absence of neurological symptoms
• Normal otological examination
• Positive Dix-Hallpike manoeuvre or positive supine lateral head turn

Question 3

INVESTIGATIONS

Answer 3

• Dix-Hallpike manoeuvre
• Supine lateral head turns

Question 4

INVESTIGATIONS

How do you do Dix-Hallpike manouvre

Answer 4

1. Patient sits upright on flat examination couch with head turned 45 degrees to one side
2. Support patients head to stay 45 degree position while rapidly lowering the patient backwards until their head hanging off end of couch, extended 20-30 degrees
3. Hold head still, turned 45 degrees to one side and extended 20-30 degrees below level of couch
4. Watch eyes closely for 30-60 seconds for nystagmus
5. Repeat with head in other direction

Question 5

MANAGEMENT

First line

Answer 5

Epley manoeuvre