BPPV Vestibular Exam Flashcards
CONTRAINDICATIONS to Dix Hallpike that must be asked
hx of neck surgery
recent neck trauma
severe RA
OA instability
cervical myelopathy
cervical radiculopathy
carotid sinus syncope
Chiari malformation
vascular dissection syndromes
5 Ds and 3 Ns
dizziness, dysarthria, dysphagia, drop attack, diplopia
nausea, numbness, nystagmus
parameters to be met before testing (clearing)
check hx/contras
C spine AROM (observe for Ds and Ns)
extend and rotate to each side in sitting, counting back from 10
clear transverse and alar ligament
VBAI screen supine
body moving on head test
checklist before beginning BPPV testing
test less suspected side 1st
get trashcan
perform with Frenzel goggles in room light
which canal involved?
upbeat, right torsional
R posterior
which canal involved?
downbeat, right torsional
R anterior
which canal involved?
downbeat, left torsional
L anterior
which canal involved?
upbeat, left torsional
L posterior
the head should be rotated ____ degrees for Dix Hallpike
45 deg
the head should be extended ____ degrees for Dix Hallpike
~ 30 deg
how long to hold Dix Hallpike
1 minute
OR 30 sec after dizziness subsides
canal vs cupulalithiasis
canal - nystagmus & dizziness >1 min
cup - as long as in position
most important part of vetibular exam
subjective
how to ask pt to describe their dizziness
describe the sensation without using the word “dizzy”
oscillopsia indicates ____ vestibular dysfunction
bilateral
cardiovascular descriptions of dizziness
light-headed, pre-syncope, tunnel visison
important things to screen to differentially diagnose vestibular issue
ask about meds
take vitals
co-morbidities
an atypical oculomotor screen indicates ___ issue
central
an atypical VOR screen indicates ___ issue
peripheral, non-BPPV
what is the HINTS exam for?
detect acute stroke
screens for postural control/balance
gait w/ head turns
Romberg
Tandem
Fukuda
repulsion test (pull at hips)
issues with repulsion test indicate ____ dysfunction
basal ganglia
4 categories for vestibular screening
peripheral vestibular
central vestibular stable
central vestibular unstable
imbalance
canalithiasis presentation
latent onset of vertigo and nystagmus
sx gradually intensify and subside
sx last <1 min
cupulalithiasis presentation
immediate onset of vertigo & nystagmus
sx intensity constant
sx last as long as in provoking position
BPPV test sequence
Dix-Hallpike
Roll Test
Side-lying Test
T/F: if Dix-Hallpike is positive, keep going to complete other 2 tests in the sequence
F
Ewald’s 1st Law
eye movements are in the plane of the canal being stimulated
Ewald’s 3rd Law
for anterior and posterior canal, deflection of cupula towards canal creates stronger excitatory response
Ewald’s 2nd Law
excitation of any canal creates a stronger vestibular stimulus and created a greater response than inhibition
how are the horizontal canals oriented?
30 deg above horizon
geotrophic nystagmus in roll test indicates what issue
canallithiasis
apogeotrophic nystagmus in roll test indicates what issue
cupulalithiasis
what is the alternative test for pts that cannot tolerate Dix Hallpike?
Side-lying Test
if pt has nystagmus in the roll test that is geotropic and beats faster when the L ear is down, what is suspected?
L canalithiasis
if pt has nystagmus in the roll test that is apogeotropic and beats faster when the L ear is down, what is suspected?
R cupulolithiasis
what is suspected:
upbeat and L rotary nystagmus in side-lying test
L posterior canal
what is suspected:
downbeat and L rotary nystagmus in side-lying test
L anterior canal
+ side-lying test for anterior canal BPPV
downbeat and rotary nystagmus of downside ASC
+ side-lying test for posterior canal BPPV
upbeat and rotary nystagmus of downside PSC
T/F: you always treat vertigo 1st
T
how to tell if vestibular issue is BPPV or not
non-BPPV follows Alexander’s Law - nystagmus increases when look towards side it’s beating to (ex: look L increases L beating nystagmus)
