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Benign Paroxysmal Positional Vertigo (BPPV)

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Topic updated on 01/11/17 11:34am

Snapshot
  • A patient presents to your office complaining of a sensation that the room is spinning around them. These symptoms tend to come on when the patient goes from laying or sitting to standing. The patient denies hearing loss or tinnitus and has no ataxia. On physical exam there is a positive Dix-Hallpike maneuver.
Overview
 
Disease Characteristics
Symptoms Diagnostic Test Treatment
Benign positional vertigo
  • Changes with position
  • Vertigo without hearing loss, tinnitus, or ataxia
  • MRI of internal auditory canal
  • Diagnosis: Dix-Hallpike maneuver
  • Treatment: Epley maneuver
  • Meclizine
Vestibular neuritis
  • Vertigo without postion changes
  • Vertigo but no hearing loss or tinnitus (inflammation of vestibular portion of CN VIII)
  • Meclizine
Labyrinthitis
  • Acute, self-resolving episode
  • Vertigo
  • Hearing loss
  • Tinnitus
  • Self-limited
  • Meclizine + steroids
Meniere's disease
  • Chronic remitting and relapsing episodes
  • Vertigo
  • Hearing loss
  • Tinnitus in a chronic remitting and relapsing manner
  • Diuretics
  • Salt restriction
  • Unilateral CN VIII ablation (severe cases)
Perilymph fistula
  • History of trauma
  • Vertigo from Trauma
  • Fix damage surgically
Acoustic neuroma
  • Ataxia
  • Neurofibromatosis type II
  • MRI findings
  • Vertigo
  • Hearing loss
  • Tinnitus AND ataxia
  • Surgical intervention
 
Introduction
  • A common form of peripheral vertigo
  • Results from a dislodged piece of otolith
    • causes disturbances in the semicircular canals
    • motion can disturb the otolith and improve or exacerbate symptoms
Presentation
  • Sudden episodic vertigo with head movements   
    • last for seconds
  • Horizontal nystagmus with specific head postures
  • Accompanied by nausea and vomiting
Evaluation
  • Reproduced during Dix-Halpike maneuver
    • patients lies supine and quickly turns head to side
  • Rule out other etiologies with imaging, audiograms, and TSH levels
Treatment
  • Treat with repositioning exercises (Epley maneuver)
  • Meclizine


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Qbank (1 Questions)

TAG
(M2.ET.4) A 60-year-old female presents to an outpatient clinic with complaints of "dizziness." Based on the patient's otherwise unremarkable medical history and age, you suspect benign paroxysmal positional vertigo. Which of the following elements in this patients history would be consistent with this diagnosis? Topic Review Topic

1. Dizziness when standing still
2. Dizziness when rolling over in bed
3. Dizziness when straining on the toilet
4. Dizziness with hearing loss
5. Dizziness with severe headache

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