Benign Paroxysmal Positional Vertigo

Question 1

Definition

Answer 1

Sudden, short lived episodes of vertigo elicited by head perturbation. One of the most common causes of vertigo and can become chronic and relapsing.
- Classified as peripheral vestibular disorder

Question 2

Epidemiology + Risk factors

Answer 2

Increasing age >50+
Female
Head trauma
Inflammation
Migraines

Question 3

Types of vertigo

Answer 3

BPPV = short duration on head perturbation
Meniere’s disease = hours, accompanied by tinnitus, hearing loss and fullness in ear
Labyrinthitis = > viral infection -> vertigo and hearing loss lasting days
Vestibular neuritis = > viral infection -> vertigo, NO HL

Question 4

Pathophysiology

Answer 4

Labyrinth in inner ear contains calcium crystals = otoliths
BPPV = migration of otoliths from utricle into semi-circular canal
Posterior canal = most commonly affected

Question 5

Signs

Answer 5

Positive Dix-Hallpike manoeuvre =
- Vertigo reproduced
- Torsional nystagmus = eye rotates towards the affected ear
- Nystagmus is fatigable and lasts for up to 1 minute
Normal neurological examination
Positive supine lateral head turn = suggestive of lateral canal BPPV

Question 6

Symptoms

Answer 6

Episodes of vertigo
- Sudden and severe < 30 seconds
- Episodic and occur on head movement
Triggers: rolling over in bed, reclining or gazing upwards
Nausea and vomiting: often persist for longer

Question 7

Diagnosis

Answer 7

Evidence of a history suggestive of BPPV and one of the following:
- Positive Dix-Hallpike manoeuvre (anterior or posterior canal BPPV) or
- Positive supine lateral head turn (lateral canal BPPV): very similar to Dix-Hallpike but the patient remains supine instead of hanging their head off the end of the bed

Question 8

Treatment

Answer 8

FIRST LINE =
- Conservative = patient education and reassurance
- Particle-repositioning manoeuvres (PRMs) :
Epley manoeuvre
SECOND LINE =
- Vestibular suppressant medication = PROCHLORPERAZINE or BETAHISTINE