Benign paroxysmal positional vertigo Flashcards
What is BPPV?
Vertigo lasting s to mins on changing head position (e.g. sitting to lying down or turning head suddenly)
Describe the aetiology of BPPV
Displacement of otoliths into the semicircular canals
What are Otoliths?
Calcium carbonate crystals
List 8 risk factors for BPPV
F > M Increasing age Head trauma Vestibular neuronitis Labryrinthitis Migraines Inner ear surgery Ménière disease
List 4 symptoms of BPPV
Dizziness
Vertigo: SUDDEN ONSET + EPISODIC + usually < 30s (attacks repeatedly over wks – months)
Loss of balance or unsteadiness
N + V
What are the signs of BPPV?
No signs;
Normal neuro + otological exam
What investigations are used for suspected BPPV? What is each test used for?
Dix-Hallpike test: Dx post. canal BPPV
Supine lateral head turns: Dx lateral canal BPPV
Describe the Dix-Hallpike test
Stand behind pt, turn their head 45 to one side
Supporting the neck, lay the patient flat in 1 quick smooth movement, ensuring the head hangs over the end of the bed.
Ask pt to keep their eyes open + observe for abnormal eye movements. You should observe for at least 30s
.Vertigo within 1–5s, nystagmus (reversible with sitting: L.ear= clockwise torsional nystagmus; R.ear= anti-clockwise)
Describe the use of supine lateral head turns as a test for BPPV. What is seen in a positive test?
DR places pt in a supine position + flexes the neck 30° from horizontal to bring the lateral canals into the vertical plane of gravity.
Head is then rotated to one side for a moment + then rotated to the opposite side.
Positive= pt experiences vertigo with nystagmus.
How is BPPV treated?
Epley manouvre
What question may you ask if you suspect BPPV?
Whether dizziness worsens when rolling around in bed
What may cause displacement of otoliths into semicircular canals?
Degeneration, trauma or post-viral
Most are idiopathic
What is seen in a positive Dix Hallpike test?
Pt experiences vertigo + nystagmus.
