Benign Paroxysmal Positional Vertigo

Question 1

Define BPPV

Answer 1

Peripheral vestibular disorder that causes sudden shortlived episodes of vertigo caused by head movement

Question 2

What are the causes/risk factors of BPPV?

Answer 2

Primary – idiopathic (50-70%)
Secondary – displacement of otoliths into the canal
• Head trauma
• Labyrinthitis
• Ménière’s disease
• Migraine

Question 3

What are the symptoms of BPPV?

Answer 3

• Sudden onset, brief, episodic
vertigo
• Provoked by looking up, bending
down, getting up, turning head,
rolling over in bed
• Nausea
• Lightheadedness
• Imbalance

Question 4

What are the signs of BPPV?

Answer 4

• Normal neurological/ontological
examination
• Positive Dix-Hallpike manoeuvre

Question 5

What investigations are carried out for BPPV?

Answer 5

• Dix-Hallpike Manoeuvre: Used to diagnose posterior canal BPPV.

• 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.

• Supine Lateral Head Turns: Used to diagnose lateral (horizontal) canal BPPV.

• The clinician places the patient in a supine position and, ideally, flexes the neck 30° from horizontal to bring the lateral canals into the vertical plane of gravity. However, it is sufficient and more usual to simply lay the patient flat on his or her back.
• The head is then rotated to one side, left for a minute, and then rotated to the opposite side.
• Similar to the Dix-Hallpike manoeuvre, a positive test is noted when the patient experiences vertigo with nystagmus.