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- Benign Paroxysmal Positional Vertigo (BPPV)
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Most BPPV cases are diagnosed with a focused history and accurate physical examination. During positional testing, the Dix-Hallpike maneuver is performed first. The maneuver is positive when there is a period of latency followed by upbeating, torsional, geotropic nystagmus that crescendos and lasts for less than a minute. When the Dix-Hallpike maneuver is negative, the supine roll test is administered. Two key points to note in this test are 1 nystagmus direction should remain in the same direction, either geotropic or apogeotropic and 2 the side with worse symptoms. The direction of nystagmus differentiates between HSC canalithiasis and cupulolithiasis and canalithiasis of the ampullary side.
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The side with worse symptoms identifies the affected side. Upon diagnosis, the patient is treated in the same setting using the PRM. A Cochrane review including 11 trials with patients showed it to be more effective than sham maneuvers and controls,1 3 and we have shown the success rate to be With repeated Epley maneuvers, the success rate increases to Variations of this maneuver are the most widely studied. Our data also show a higher success rate with the barbecue roll maneuver than the previous studies and support the use of this maneuver in patients with both variants of HSC-BPPV.
Symmetrical responses during the supine roll test can occur in up to 9. If the patient does not seem to respond to the barbecue maneuver for one side, the maneuver can be performed for the opposite side during the next follow-up. Alternatively, the affected side can be identified using secondary clinical signs. These maneuvers have been described and used by departments with high volumes of vertiginous patients. In the primary care setting, we recommend mastery of one maneuver, before attempting other maneuvers.
When canaliths are localized to the nonampullary arm of the posterior canal, near the common crus, an apogeotropic variant of posterior BPPV is observed. PRMs have not found to be effective and symptoms resolve spontaneously within two weeks.
None of these uncommon variants of BPPV were present in our study. Videonystagmography was not part of our physical examination, and perhaps this group of patients were misdiagnosed. In primary practice, it will be extremely difficult to diagnose this subset of patients. Thus, we recommend these patients to be referred on to a tertiary center for further evaluation to exclude more sinister causes such as neurological pathology. Our study showed an incidence of 0. Refractory cases occur when debris lodge on the ampullated ends of the ASC, near the cupula.
Debris in this position is held in place by gravity. A high index of suspicion is required, and specific maneuvers must be used. Yacovino DA et al described a new therapeutic maneuver for ASC-BPPV that does not require identification of the affected side, 30 thus facilitating immediate treatment and increasing the success rate.
Interestingly, in a study by Riggio F et al, the conversion rate was After successful PRMs, it is common for patients to experience a period of imbalance without positional vertigo residual dizziness. While the pathophysiology is unclear with many proposed theories, the key point is to reassure patients that residual dizziness usually resolves after a period of time and that pharmacological therapy may not be helpful in preventing its onset. In summary, doctors should familiarize themselves with the diagnostic tests for BPPV.
The two key points to note during the positional tests are the presence of nystagmus and its direction. The diagnosis is made instantaneously and the patient can be treated at the same office setting, leading to relief of symptoms. Familiarity with PRMs and repeat practice may improve the success rate.
Patients that have been treated should be reevaluated in a timely fashion so the maneuver can be repeated if necessary. Patients who are unable to comply with the maneuvers such as neck stiffness , whose symptoms persist after repeated maneuvers or whose symptoms are atypical should be referred to a tertiary center for further evaluation to exclude other causes. National Center for Biotechnology Information , U.senjouin-kikishiro.com/images/cazudeto/1309.php
Benign Paroxysmal Positional Vertigo (BPPV)
Ther Clin Risk Manag. Published online Jun Author information Article notes Copyright and License information Disclaimer. Received Jan 29; Accepted May 9. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
For permission for commercial use of this work, please see paragraphs 4. Abstract Background: Benign paroxysmal positional vertigo BPPV is a common cause of vertigo that can be easily diagnosed and treated in primary care.
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Introduction Vertigo is one of the commonest complaints in medical practice and may present to a wide range of clinicians, including general practitioners, otolaryngologists and neurologists. Open in a separate window. ISSN: Previous article Next article. Issue 4. Pages July - August Download PDF.
Clara Silva. Corresponding author. This item has received. Article information. Introduction and objective Benign paroxysmal positional vertigo is one of the most common vestibular disorders, with a lifetime prevalence of 2. This study aimed to assess age, gender, lesion type and site, association with other vestibular diseases, progression and recurrence in a Portuguese population. Methods This was a retrospective observational study of patients diagnosed with benign paroxysmal positional vertigo by the same senior doctor, in a tertiary academic hospital, between January and May Results A total of cases were pooled, with a mean age of No association was found between the number of maneuvers necessary to treat benign paroxysmal positional vertigo and etiology.
Conclusion Benign paroxysmal positional vertigo is more frequent in female subjects, in the 6th decade and involves preferably the posterior semicircular canal of the right labyrinth. Our results were in accordance with the literature; nevertheless, in this study the left labyrinth was most affected and the follow-up period was variable. Palabras clave:. Introduction Benign paroxysmal positional vertigo BPPV is one of the most common vestibular disorders.
Materials and Methods Retrospective observational study of patients diagnosed with BPPV, by the same senior doctor, in a tertiary academic hospital, between January and May , with a mean follow-up of Age, gender, race, type and site of lesions, etiology, association with other vestibular diseases, presence of cardiovascular risk factors, exams, disease progression and recurrence were recorded. Results A total of cases were pooled with a mean age of All patients were Caucasian. From MRI: two cases showed white matter periventricular disease, one patient with a vascular conflict of the eight cranial nerves and a case of demyelinating lesions; and one case of a cerebellopontine angle lipoma.
Benign Paroxysmal Positional Vertigo – A Review of Cases | Acta Otorrinolaringológica Española
Etiology of BPPV. Figure 1. Incidence of cardiovascular risk factors. Figure 2. Caldas, C. Braz J Otorhinolaryngol, 75 , pp. Lopez-Escamez, M.
Molina, M. Gamiz, A. Fernandez-Perez, M. Gomez, M. Palma, et al.
Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal positional vertigo. Acta Otolaryngol, , pp. Balatsouras, G.