Benign Paroxysmal Positional Vertigo Flashcards
BPPV
What is BPPV caused by?
loose otoliths (calcified particles) in the semicircular canals, causing disruption to the vestibular system of the inner ear
The exact cause is often unknown, but it may also occur as a consequence of head injury, viral infections, and another inner ear disorder – Meniere’s disease. BPPV, as named, is a benign disorder, but can cause debilitating symptoms, especially for those who have recurrent attacks. It is a key differential diagnosis in the presentation of “dizziness”.
BPPV
How does it present?
vertigo following movements such as turning over in bed, lying down, sitting up, looking up, or bending forward
BPPV
What are some associated symptoms/signs?
not much
maybe nausea
nystagus may be seen
BPPV
Investigations?
none specifically, diagnosed clinically
neurological examination and dix-hallpike maneuvre
BPPV
Describe the dix-hallpike maneuvre.
What is a positive test?
patient lies supine, with their head in the hands of a trained examiner extended 30 degrees beyond the horizontal neutral position.
- A positive test is reproduction of the vertigo and the eliciting of nystagmus – which is sufficient to diagnose BPPV.
The test should be performed with both the right ear facing down and then the left ear facing down.
BPPV
How is it managed? (prescribing)
self-resolving
however, for pt with recurring bppv they can take antihistamines, histamine analogues and anticholinergics for symptoms control
antihistamines: cyclizine
histamine analogue: betahistine
anticholinergics: hyoscine butylbromide
BPPV
How is it managed? (non-prescribing)
physio: epley maneuvre, semont’s maneuvre, brandt-daroff positional exercises
A surgical option is available – semicircular canal occlusion – which is reserved for very severe cases refractory to other treatment.
