Benign Paroxysmal Positional Vertigo

Question 1

What is BPPV

Answer 1

Recurrent episodes of vertigo triggered by head movement.

Question 2

Presentation of BPPV

Answer 2

A variety of head movements, including turning in bed, causes dizziness and symptoms settle after around 20-60 seconds. Asymptomatic between attacks

Question 3

Pathophysiology of BPPV

Answer 3

Caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals. Most common in posterior semicircular canal. Crystals disrupt normal flow of endolymph through the canals.

Question 4

Causes of displaced crystals

Answer 4

Viral infection, head trauma, ageing, or without clear cause

Question 5

Diagnosis of BPPV

Answer 5

Dix-Hallpike manoeuvre.

Question 6

What does the Dix-Hallpike manoeuvre involve

Answer 6

Moving the patients head in a way which moves the endolymph though the semicircular canals and triggers vertigo in patients and nystagmus

Question 7

What does nystagmus indicate in the Dix-Hallpike manoeuvre

Answer 7

There will be rotational beats of nystagmus towards the affected ear - clockwise with left ear and anticlockwise with right ear

Question 8

Treatment of BPPV

Answer 8

Epley manoeuvre

Question 9

What does the Epley manoeuvre do

Answer 9

It moves the crystals in the semi circular canals into a position which does not disrupt endolymph flow