Benign Paroxysmal Positional Vertigo Flashcards
Define BPPV.
Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements. BPPV is one of the most common causes of vertigo. It is often self-limiting, but can become chronic and relapsing with considerable effects on a patient’s quality of life.
Explain the aetiology/risk factors of BPPV.
Increasing age
Female sex
Head trauma
Vestibular neuronitis
Labyrinthitis
Migraines
Inner ear surgery
Meniere’s disease
Summarise the epidemiology of BPPV.
Primary (idiopathic) BPPV has a peak incidence between 50 and 70 years of age, but can occur in any age group. Migraine and head trauma are more common in younger patients with secondary BPPV compared with older patients with secondary disease.
Recognise the presenting symptoms of BPPV. Recognise the signs of BPPV on physical examination.
Vertigo
Nausea, imbalance, and lightheadedness
Absence of associated neurological or otological symptoms
Normal neurological and otological exam
Positive Dix-Hallpike manoeuvre
Identify appropriate investigations for BPPV and interpret the results.
Dix-Hallpike manoeuvre
Supine lateral head turns
How do you perform Dix-Hallpike manoeuvre?
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.
