Monday, 12 March 2012

Assessing vertigo

Level 1

Benign paroxysmal positional vertigo or BPPV is the most common vestibular problem in adulthood. Patients will present with vertigo - the sensation of either the room or their head spinning - typically worse on head movements. They (or a significant other) may have noticed nystagmus and this can provoke referral to many different specialities. See this YouTube video for common presentations and the underlying pathology:

We each have two sets of semi-circular canals. The diagram to the left shows a schematic diagram of one. The three canals are oriented at 90 degrees to each other, providing information about head movement in any axis. For more information on the anatomy, see the following YouTube video:

The Hallpike manoeuvre (or Dix-Hallpike Test) is a simple and useful addition the arsenal of clinical tests for many clinicians, including Neurologists, ENT surgeons, GPs, Geriatricians and A&E doctors. We would encourage medical students to learn about it. A Hallpike manoeuvre is positive when it provokes nystagmus (as witnessed by the examiner) and vertigo (as felt by the patient) - this is strongly suggestive that the underlying diagnosis is BPPV.

The manoeuvre was first described in M. R. Dix and C. S. Hallpike: The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. The Annals of Otology, Rhinology and Laryngology, December 1952, 61 (4): 987-1016. For more modern guidance on the details of the test, see The British Society of Audiology's guidance.

The importance of the test is all the more apparent as a positive test indicates the presence of posterior canal BPPV; negating the need for further cli tests and offering the potential for an easy treatment in the form of the Epley manoeuvre:

For one more video covering the Hallpike and Epley, click here

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