Benign Paroxysmal Positional Vertigo

Question 1

Is BPPV the commonest cause of peripheral vertigo?

Answer 1

Yes

Question 2

What is the average age of onset?

Answer 2

55

It is less common in younger patients

Question 3

What symptoms occur?

Answer 3

Vertigo triggered by change in head position e.g rolling over in bed or gazing upwards
May be associated with nausea

Question 4

How long does each episode typically last?

Answer 4

10-20 seconds

Question 5

What causes BPPV?

Answer 5

Solid crystal fragments (otoliths) in the endolymph move hair cells and stimulate the semicircular canals
Extra, conflicting signals sent to the brain
Can occur after head injury or viral illness e.g previous labrynthitis

Question 6

How is it diagnosed?

Answer 6

Establish important negatives - no persistent vertigo, no speech, visual, sensory or motor problems, no tinnitus, headache, ataxia, facial numbness or dysphagia, no vertical nystagmus

Dix -Hallpike test positive

Question 7

What is the prognosis?

Answer 7

Good, usually resolves spontaneously after a few weeks or months

Question 8

What is the Dix-Hallpike manoeuvre?

Answer 8

A diagnostic examination

Turn patient’s head 45 degrees towards test ear - maximal stimulation of posterior circular canal on lying
Continue to hold patients head and ask them to lie back, then lower their head a further 30 degrees below level of couch
Ask patient if they feel dizzy and look for nystagmus

If positive there is vertigo and rotatory nystagmus towards to under most ear, after latent period of 5 to 10 sec. this lasts less than 30 sec and is fatiguable. On sitting there is more vertigo and nystagmus.

Question 9

How is it managed?

Answer 9

Usually self limiting
If persisting: Epley manoeuvre, vestibular rehabilitation (home exercises) - called Brandt-Daroff exercises

Betahistine medication often prescribed, but tends to be of limited value

Question 10

Does vestibular suppressant medication stop the vertigo?

Answer 10

No

Question 11

How successful is the Epley manoeuvre?

Answer 11

80%

Question 12

Describe the Epley manoeuvre

Answer 12

Head moved through four sequential positions, resting for 30 seconds between each

Aim: reposition the otoliths away from the sensitive posterior canal and into the vestibule

Question 13

Where are crystals typically located?

Answer 13

Posterior canal - causing rotatory nystagmus

Question 14

If crystals in the lateral canal what type of nystagmus is seen?

Answer 14

Horizontal nystagmus

Question 15

How long do the symptoms typically last?

Answer 15

Seconds to minutes