Benign Paroxysmal Positional Vertigo (BPPV)
Definition
Acute attacks of transient vertigo lasting seconds to minutes initiated by certain head positions, accompanied by torsional (i.e. rotatory) nystagmus (geotropic= fast phase towards the floor)
NOTE: Most common cause of vertigo
Aetiology
Canalithiasis (migration of free floating otoliths within the endolymph of the semicircular
canal) or cupulolithiasis (otolith attached to the cupula of the semicircular canal)
Diagnosis
History
Positive Dix-Hallpike maneuver (only present in 50-80% of patients)
Dix-Hallpike Positional Testing
5 Signs of BPPV Seen with Dix-Hallpike Manoeuvre
Treatment
Source
Toronto Notes 2012
Acute attacks of transient vertigo lasting seconds to minutes initiated by certain head positions, accompanied by torsional (i.e. rotatory) nystagmus (geotropic= fast phase towards the floor)
NOTE: Most common cause of vertigo
Aetiology
Canalithiasis (migration of free floating otoliths within the endolymph of the semicircular
canal) or cupulolithiasis (otolith attached to the cupula of the semicircular canal)
- Can affect each of the 3 semicircular canals, although the posterior canal is affected in >90% of cases
- Causes: head injury, viral infection (URTI), degenerative disease, idiopathic
- Results in slightly different signals being received by the brain from the two balance organs resulting in sensation of movement
Diagnosis
History
Positive Dix-Hallpike maneuver (only present in 50-80% of patients)
Dix-Hallpike Positional Testing
- The patient is rapidly moved from a sitting position to a supine position with the head hanging over the end of the table, turned to one side at 45° holding the position for 20 s (do it for the other side and centre too)
- Onset of vertigo is noted and the eyes are observed for nystagmus
5 Signs of BPPV Seen with Dix-Hallpike Manoeuvre
- Geotropic rotatory nystagmus (nystagmus MUST be present for a positive test)
- Fatigues with repeated maneuver
- Reversal of nystagmus upon sitting up
- Latency of ~20 sec
- Crescendo/decrescendo vertigo lasting 20 sec
Treatment
- Reassure patient that process resolves spontaneously
- Particle repositioning manoeuvres
- Epley manoeuvre (performed by Dr) - Main rx
- Brandt-Daroff exercises (performed by patient)
- Surgery for refractory cases (rare)
- Anti-emetics for nausea/vomiting
Source
Toronto Notes 2012