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DPT 761 - Neuro Rehab II > Posterior Canal BPPV > Flashcards

Posterior Canal BPPV Flashcards

1
Q

What does BPPV stand for?

A

BPPV stands for Benign Paroxysmal Positional Vertigo.

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2
Q

What does ‘benign’ mean in BPPV?

A

Benign means it does not result in permanent vestibular dysfunction and is not due to CNS pathology.

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3
Q

What does ‘paroxysmal’ mean in BPPV?

A

Paroxysmal means the symptoms occur in sudden, brief spells.

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4
Q

What does ‘positional’ mean in BPPV?

A

Positional means the symptoms are triggered by certain head movements or positions.

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5
Q

What does ‘vertigo’ mean in BPPV?

A

Vertigo refers to a false sense of movement, usually described as room spinning.

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6
Q

What are the primary symptoms of BPPV?

A

Primary symptoms of BPPV include episodes of vertigo triggered by head movements, lasting less than a minute.

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7
Q

What common activities can trigger BPPV symptoms?

A

Common activities that can trigger BPPV include looking overhead, lying down, getting out of bed, rolling over in bed, and bending over.

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8
Q

How long do BPPV episodes typically last?

A

BPPV episodes typically last less than 1 minute.

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9
Q

What percentage of dizziness cases in clinics are due to BPPV?

A

17-42% of dizziness cases in clinics are due to BPPV.

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10
Q

Which age group is most commonly affected by BPPV?

A

BPPV is most common in individuals aged 50-70.

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11
Q

What are some common causes of BPPV?

A

Common causes of BPPV include age, head trauma, vestibular neuritis, and prolonged positioning with the ear in a dependent position.

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12
Q

What is the role of otoconia in BPPV?

A

Otoconia, or calcium carbonate crystals, become dislodged from the utricle and migrate into a semicircular canal, causing BPPV.

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13
Q

What are the age-related changes in otoconia that contribute to BPPV?

A

As we age, otoconia can hypertrophy, develop cracks, and break off, increasing the risk of BPPV.

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14
Q

What is canalithiasis?

A

Canalithiasis is caused by free-floating otoconia within a semicircular canal, leading to short-duration vertigo and nystagmus.

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15
Q

What is cupulolithiasis?

A

Cupulolithiasis occurs when otoconia adhere to the cupula, causing longer-lasting vertigo and nystagmus.

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16
Q

Which semicircular canal is most commonly affected by BPPV?

A

The posterior semicircular canal is most commonly affected by BPPV.

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17
Q

What is the difference between canalithiasis and cupulolithiasis in terms of symptoms?

A
  • Canalithiasis typically results in vertigo lasting less than 1 minute.
  • Cupulolithiasis causes vertigo lasting more than 1 minute.
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18
Q

What are the typical findings in a subjective examination for BPPV?

A

Subjective examination findings for BPPV include vertigo lasting less than 1 minute, triggered by head movements, with possible nausea and imbalance.

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19
Q

What are the expected results in a gross neuro screen for BPPV?

A

In BPPV, gross neuro screen results are typically normal, including normal oculomotor and head impulse tests.

20
Q

What is the Dix-Hallpike test?

A

The Dix-Hallpike test is the gold standard for diagnosing posterior canal BPPV.

21
Q

How is the Dix-Hallpike test performed?

A

The Dix-Hallpike test is performed by turning the patient’s head 45° to one side while in long sitting, then quickly moving the patient to a supine position with the head extended 20°.

22
Q

What is a positive Dix-Hallpike test indicative of?

A

A positive Dix-Hallpike test, indicated by vertigo and nystagmus, suggests posterior canal BPPV.

23
Q

What type of nystagmus is associated with posterior canal BPPV?

A

Posterior canal BPPV is associated with upbeating and torsional nystagmus.

24
Q

What type of nystagmus is associated with anterior canal BPPV?

A

Anterior canal BPPV is associated with downbeating and torsional nystagmus.

25
Q

What is the Sidelying test and when is it used?

A

The Sidelying test is an alternative to the Dix-Hallpike test, used for patients with limited cervical mobility.

26
Q

How is the Sidelying test performed?

A

The Sidelying test is performed by rotating the patient’s head 45° away from the side being tested, then quickly bringing the patient into sidelying on the tested side.

27
Q

What is the primary intervention for posterior canal BPPV?

A

The primary intervention for posterior canal BPPV is repositioning maneuvers.

28
Q

What is the Epley maneuver?

A

The Epley maneuver, or Canalith Repositioning Maneuver, is used to treat posterior canal BPPV.

29
Q

How is the Epley maneuver performed?

A

The Epley maneuver involves moving the patient’s head through a series of positions to move otoconia out of the semicircular canal and back into the vestibule.

30
Q

What is the purpose of the Epley maneuver?

A

The purpose of the Epley maneuver is to reduce vertigo and nystagmus by repositioning the otoconia.

31
Q

What modifications can be made to the Epley maneuver?

A

Modifications to the Epley maneuver include performing it on a tilt table or with the patient’s head supported on a pillow.

32
Q

What is the Semont maneuver?

A

The Semont maneuver is another repositioning maneuver, originally designed for cupulolithiasis but also effective for canalithiasis.

33
Q

How is the Semont maneuver different from the Epley maneuver?

A

The Semont maneuver involves rapid movements to dislodge debris, while the Epley maneuver involves more gradual head positioning.

34
Q

When is the Semont maneuver typically used?

A

The Semont maneuver is typically used when the patient cannot tolerate the supine position.

35
Q

What are the success rates for the Epley and Semont maneuvers?

A

Success rates for the Epley maneuver are 57.1% after one treatment and up to 91.5% after multiple treatments. The Semont maneuver has a 62.6% remission rate after one treatment and 90% after multiple treatments.

36
Q

What are the recommendations for post-maneuver activity restrictions?

A

Post-maneuver activity restrictions are generally not recommended, though patients may be advised to avoid lying flat or looking at the ceiling for a few hours.

37
Q

.

A

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38
Q

What should be done if BPPV symptoms do not resolve after 3-5 visits?

A

If BPPV symptoms do not resolve after 3-5 visits, further evaluation or referral to a specialist may be needed.

39
Q

What role does vestibular rehabilitation therapy (VRT) play in BPPV treatment?

A

Vestibular rehabilitation therapy (VRT) may be used as an adjunct to repositioning maneuvers, especially in patients with residual imbalance or dizziness.

40
Q

What are some considerations for patients with bilateral BPPV?

A

For patients with bilateral BPPV, treat the more symptomatic side first and the other side in subsequent sessions.

41
Q

What is the recurrence rate of BPPV?

A

The recurrence rate of BPPV is approximately 35%.

42
Q

What are the risk factors for recurrent BPPV?

A

Risk factors for recurrent BPPV include older age, head trauma, Meniere’s disease, vestibular neuritis, diabetes, and low Vitamin D levels.

43
Q

How should patients be educated about BPPV recurrences?

A

Patients should be informed that BPPV management may require repeated treatments, and recurrences are possible.

44
Q

What are the contraindications for performing positional testing in BPPV?

A

Contraindications for positional testing include signs or symptoms of vertebrobasilar insufficiency (VBI) or cervical spine instability.

45
Q

What is the significance of using infrared video goggles in BPPV diagnosis?

A

Infrared video goggles are useful in BPPV diagnosis because they can detect subtle nystagmus that may not be visible in room light.

DPT 761 - Neuro Rehab II (16 decks)

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