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Dizziness
Published in Henry J. Woodford, Essential Geriatrics, 2022
If possible, any underlying cause should be treated, for example, discontinuation of culprit medications or performing the Epley manoeuvre for BPPV. There is a risk that acute symptoms can become chronic in nature.8
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Benign paroxysmal positional vertigo (BPPV): this is a common inner ear disorder characterized by brief attacks of vertigo precipitated by head movement and associated with nystagmus and autonomic symptoms. The vertigo typically lasts < 30 seconds. Symptoms may occur repeatedly throughout the day. BPPV is due to canalithiasis (otoconia dislodge from the macule of the utricle and become free floating in a SCC) or cupulolithiasis (otoconia become adherent to the matrix gel of the cupula). Most cases of BPPV are due to posterior canalithiasis. The diagnosis of BPPV is confirmed with the Dix–Hallpike maneuver. In posterior canal BPPV, after head tilt toward the affected ear, vertigo develops with concomitant nystagmus with an upbeat and torsional component. The nystagmus develops a few seconds after positioning the patient, fatigues within 30 seconds, and habituates with repeated attempts. Symptoms may last for weeks and may recur.39 With a central lesion, symptoms develop when the head is turned to either side during the testing maneuver; the vertigo is usually mild and brief; the nystagmus changes direction when the head is turned from one side to the other, and is not fatigable. Treatment of BPPV consists of repositioning maneuvers40 (Epley's and Semont's maneuvers).
Benign paroxysmal Positional Vertigo
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Yougan Saman, Doris-Eva Bamiou
Diagnosis of BPPV is made on the basis of typical signs (nystagmus) and symptoms (vertigo and nausea) provoked by specific positional tests. Understanding the characteristic eye movements during these tests will help in making the diagnosis.41 Our understanding of vestibular eye movements is based on fundamental principles described by Ewald: The direction of eye movement is in the plane of the canal or canals that are stimulated.In the horizontal canal, endolymph flow towards the ampulla (ampullopetal) results in an excitatory and stronger response than flow away from the ampulla (ampullofugal), which is inhibitory. The opposite holds true for the vertical canals. For example, the posterior canal and anterior canal pairs are stimulated when performing the Dix–Hallpike test. The patient is seated along the couch, feet up, and the head is turned 45 degrees towards the side being tested, aligning the vertical canals with the sagittal plane. The head is brought down briskly over the end of the couch to lie 30 degrees below the horizontal while maintaining a position 45 degrees to the side being tested. Patients should be counselled prior to the test about dizziness but that they are to try and maintain their eyes open for examination.
Efficacy of Epley’s canalith repositioning procedure according to the number of repetitions in the same session: comparison of three protocols
Published in Acta Oto-Laryngologica, 2021
Ruggero Lapenna, Mario Faralli, Laura Cipriani, Vincenzo Marcelli, Giampietro Ricci
The inclusion criteria were as follows:Age between 18 and 65.Typical nystagmus for PSC BPPV with the Dix-Hallpike positional test, and with no variability in canal involvement.First BPPV episode or no recent recurrence in at least the previous 3 months.Absence of comorbidities that could interfere with the correct performance of the Epley CRM (i.e. cervical arthrosis, ictus, costal fractures, etc.).Idiopathic BPPV (i.e. not secondary to head trauma).
Analysis of Dix-Hallpike maneuver induced nystagmus based on virtual simulation
Published in Acta Oto-Laryngologica, 2021
Yanyan Zheng, Shuzhi Wu, Xiaokai Yang
Benign positional paroxysmal vertigo (BPPV) is a disorder of the inner ear characterized by recurrent transient vertigo induced by changes in head position relative to the direction of gravity and is one of the most common causes of vertigo. The Dix-Hallpike maneuver is the gold standard for diagnosing BPPV of vertical semicircular canals [1]. Since the Dix-Hallpike maneuver can induce otoliths movement in almost all semicircular canals, even inducing otoliths from the utricle into the semicircular canals, the nystagmus can take various forms, including horizontal nystagmus, torsional nystagmus with a vertical upward component or vertical downward component, and vertical nystagmus alone. How to interpret the nystagmus induced by the Dix-Hallpike maneuver has been the hotspot and difficulty of research [2–5].
Evidence-based management of patients with vertigo, dizziness, and imbalance at an Australian metropolitan health service: an observational study of clinical practice
Published in Physiotherapy Theory and Practice, 2020
Melanie Lloyd, Alexandra Mackintosh, Catherine Grant, Fiona McManus, Anne-Maree Kelly, Harin Karunajeewa, Clarice Y. Tang
Adult patients (≥ 18 years) presenting with dizziness, vertigo, or imbalance symptoms documented at ED triage were eligible for inclusion in the study. Individuals were excluded from the audit if the documented diagnosis post-medical assessment revealed a clear non-vestibular cause for their symptoms. Such causes included central neurological pathology (e.g., ischemic or hemorrhagic stroke); hypoglycemia; hypotension; hypoxemia; syncope; and cardiac arrhythmia. The medical records of the remaining individuals for whom a vestibular cause of symptoms was not ruled out during medical examination were audited using the standardized tool (Appendix 1). Presenting symptoms, rather than the primary diagnosis code, were used to identify eligible participants due to published high rates of misdiagnosis in dizziness presentations (Kerber and Newman-Toker 2015; Polensek and Tusa 2009; Wang et al. 2014). While typically characterized by positional or episodic vertigo, patients with BPPV may present with other symptoms such as subjective imbalance, lightheadedness, dizziness, or falls (Abbott et al. 2016; Von Brevern et al. 2007), so a high index of suspicion and appropriate clinical evaluation of patients with these symptoms is required. It was expected, for the purposes of the audit, that screening for this condition should form part of preliminary diagnostic assessment unless contraindicated through identification of a concurrent urgent medical condition, or a clear non-vestibular diagnosis was made.