Benign Paroxysmal Positional Vertigo (BPPV)

Question 1

Define

Answer 1

DEFINITION: vertigo lasting seconds to minutes on changing head position (e.g. sitting to lying down or turning the head suddenly)

Question 2

Causes

Answer 2

• Displacement of otoliths (from degeneration, trauma or post-viral, but most are idiopathic) into the semicircular canals

Otoliths are Calcium carbonate crystals

RF: Female, increasing age, head trauma, vestibular neuronitis, labryrinthitis, migraines, inner ear surgery and Meniere’s l

Question 3

Symptoms

Answer 3

• Dizziness
• Vertigo – HAS TO BE SUDDEN ONSET + EPISODIC + usually <30secs (attacks repeatedly over wks – mnths)
• Loss of balance or unsteadiness
• Nausea/vomiting

Question 4

Signs

Answer 4

No signs (norm neuro exam and otological exam )

Question 5

Investigation

Answer 5

Hallpike test – used to diagnose post. canal BPPV; vertigo within 1 – 5 secs, nystagmus (reversible with sitting: L.ear=clockwise torsional nystagmus; R.ear=anti-clockwise)

• Supine lateral head turns – used to diagnose lateral 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. 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.