vestib - BPPV

Question 1

what are 8 sx of BPPV and what is the most common one

Answer 1

dizziness
vertigo**
imbalance
“fuzzy”
n/v
nystagmus - horizontal, torsional
inc postural sway
generalized motion sensitivity

Question 2

what is the typical duration of sx

Answer 2

brief - few seconds

Question 3

what are provocative factors and commonly associated situations

Answer 3

head mvmts
- rolling over
- bending over/forward
- looking up

transfers, gardening, showering, dentist, hair salon, tying shoes

Question 4

what are possible PMH / etiologies

Answer 4

head injury
MVA
advanced age (crystals loosened)
hx of prior BPPV
idiopathic

Question 5

what are 2 important considerations about the sx seen of BPPV

Answer 5

self-imposed activity limitation common
- avoidance of certain mvmts

heightened anxiety/fear - unpredictable

Question 6

what is the mechanism of BPPV and the 2 main types

Answer 6

otoconia (aka crystals) become dislodged from gelatinous matrix that overlies otolithic membrane (utricular portion) and travels into SCC

1. canalathiasis = otoconia float freely in canal
2. cupulolithiasis = otoconia can affix themselves to cupula

Question 7

how does cupulolithiasis impact the presentation of BPPV

Answer 7

when otoconia attach to cupula, makes it heavy and pulls on it
-> causes deflection to last longer than supposed to

= sx will last longer duration than in canalithiasis

Question 8

what is the most common cause of BPPV and what are 3 other possible causes

Answer 8

idiopathic (58%)

post-traumatic (18.2%)
vestib neuritis (8.6%)
VBI (2.6%)
(other)

Question 9

what is the most common canal involved with BPPV

Answer 9

posterior

Question 10

what is the least likely canal to be involved in BPPV

Answer 10

anterior

Question 11

what specific presentation of lateral canal BPPV is most common

Answer 11

geotropic

Question 12

what is pure vertical nystagmus often indicative of

Answer 12

CNS

Question 13

posterior canal BPPV nystagmus

Answer 13

upward & torsional

Question 14

anterior canal BPPV nystagmus

Answer 14

downward & torsional

Question 15

lateral canal BPPV nystagmus

Answer 15

sx occur during head rotation to both sides
- geotropic = toward ground = canalathiasis
- apogeotropic = toward ceiling = cupulo-

Question 16

how do you determine R vs L canal involvement w geotropic vs apogeotropic lateral canal BPPV

Answer 16

intensity/speed of beatign

geotropic
- side of inc intensity = affected side

apogeotropic
- side of dec intensity = affected side

Question 17

canalathiasis vs cupulolithiasis: onset, duration, latency of sx

Answer 17

ONSET:
- can: delayed 1-40sec (takes ~25sec for otoconium to traverse 1/4 of canal)
- cup: immediate (bc wt of cupula)

DURATION:
- can: short, <60sec (crystal settles)
- cup: longer, >60sec (cont wt on cupula), lasts while person in provoking position

LATENCY:
- can: crescendo and decrescendo
- cup: no latency (immediate onset)

Question 18

what should be performed prior to exam for BPPV and why

Answer 18

cervical spine screen
- AROM (if ext or rot limited, need modifications to positional provocation tests)

• VBI (concerned ab CNS path)

Question 19

what is the significance of hx taking during a BPPV exam

Answer 19

high sensitivity (88) and specificity (92)

Question 20

what are the 4 main steps to a PT exam for BPPV

Answer 20

1. hx
2. oculomotor exam - r/o CNS vs PNS
3. cervical spine screen - AROM, VBI
4. positional provocation tests - dx
   - dix hallpike test - PCs and ACs
   - sidelying test - modified DH
   - supine roll test - HCs