Vertigo - Benign Paroxysmal Positional Vertigo (BPPV)

Question 1

Pathophysiology of BPPV.

Answer 1

Calcium Carbonate Crystals - Otoconia become displaced into the semicircular canals (especially posterior semicircular canal) and disrupt normal flow through canals.

Question 2

Aetiology of BPPV.

Answer 2

1. Viral Infection.
2. Head Trauma.
3. Ageing.
4. Idiopathic.

Question 3

Clinical Features of BPPV (5).

Answer 3

1. Triggered by Movement e.g. in bed.
2. Last around a minute before symptoms settle.
3. Over Several Week Clusters.
4. Asymptomatic between attacks.
5. No tinnitus/hearing loss.

Question 4

Investigation of BPPV.

Answer 4

Dix-Hallpike Manoeuvre.

Question 5

What is the Dix Hallpike Manoeuvre? (2)

Answer 5

1. Move patient’s head in a way that moves endolymph through canals and triggers vertigo.
2. Positive : Rotational Nystagmus (towards affected ear) and Vertigo.

Question 6

Management of BPPV (3).

Answer 6

1. Epley Manoeuvre.
2. Brandt-Daroff Exercises.
3. ?Medication = Betahistine.

Question 7

What is the aim of the Epley Manoeuvre?

Answer 7

Move crystals in the semicircular canal into a position that does not disrupt flow.