Benign positional paroxysmal vertigo Flashcards
What?
Otoconia (tiny crystals of calcium carbonate) are dislodged from utricle into semicircular canals, commonly posterior canal
Positional vertigo
Is this common or uncommon?
Very common
Causes?
Head trauma
Ear surgery
Idiopathic
Following vestibular neuronitis
Pathophysiology?
Otoconia from utricle displaced into semicircular canals
Most commonly into posterior SCC
Vertigo history?
Looking up Turning in bed - often worse to one side First lying down at night First getting up in morn Bending forward Rising from bending Moving head quickly
Clinical features?
Vertigo lasts seconds (under 1 minute)
Phenomenon becomes less severe on repeated movements (fatigue)
Onset sudden & distressing
What differentiates this from vertebrobasilar insufficiency?
VBI need other symptoms of impaired circulation in posterior brain assoc. with vertigo e.g. visual disturbances, weakness, numbness
Diagnosis?
Dix Hallpike test
Describe Dix Hallpike test?
Sit up, enough room to lay down on couch, turn head to one side
Head supported by examiner while patient lies down so their head is just below horizontal
Nystagmus (following latent interval of a few seconds) when head turned towards affected ear
Repeat with patients head towards other ear
Eyes open!
Short latency
Symptomatic or nystagmus
Vertical/torsional geotropic
They will be dizzy & maybe sick!
What type of nystagmus?
Geotropic, torsional nystagmus
Treatment?
Epley manoevre
Semont manœuvre
Brandt- Daroff exercises
Epley manœuvre?
Gentle but specific manipulation & rotation of the head to shift the loose otoliths from semicircular canals
