Benign paroxysmal positional vertigo diagnostic study of choice
Benign paroxysmal positional vertigo Microchapters |
Differentiating Benign Paroxysmal Positional Vertigo from other Diseases |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
The diagnostic study of choice for BPPV is patient history and observing nystagmus on Dix-Hall pike maneuver.
Diagnostic Study of Choice
{{#ev:youtube|https://www.youtube.com/watch?v=RNBJLed_Slc&t=4s%7C500}} |
Study of choice
The diagnostic study of choice for BPPV is patient history and observing nystagmus on Dix-Hall pike maneuver.[1][2][3]
Investigations:
- Among the patients who present with clinical signs of BPPV, the Dix-Hallpike maneuver is the most specific test for the diagnosis.
Diagnostic results
The following findings are confirmatory for BPPV:
- Recurrent brief vertigo attack which starts with certain head movements.
- Nystagmus on Dix-Hallpike maneuver.
Sequence of Diagnostic Studies
The various investigations must be performed in the following order:
If patients doesn't respond to treatment or doesn't show the typical nystagmus on Dix-Hall pike maneuver, in order to rule out other abnormalities we may perform some additional test such as:
- Electronystagmography (ENG) or video nystagmography (VNG)
- Audiometry
- Neuroimaging
For more information about these tests, click here.
Diagnostic criteria for posterial canal BPPV
Subtypes | Explanation |
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History |
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Physical exam |
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Diagnostic approach
Patient present with dizziness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Loss of consciousness? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sense of motion/ spinning? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | Sweating Heaviness sensation in the legs "Tunnel" vision Feeling warm or hot Nausea Vomiting | History of seizure Aura Post-ictal phase Uncontrollable muscle spasms Drooling or frothing at the mouth Teeth clenching Tongue biting Sudden, rapid eye movements | Yes | No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Electrolyte imbalance Intracranial process | Syncope | Seizure | Vertigo | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
M01 | A seizure is a temporary abnormal electro-physiologic phenomenon of the brain, resulting in abnormal synchronization of electrical neuronal activity. | Sudden onset? Horizental vertigo? Auditory symptoms? No neurological problem? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Peripheral | Central | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
BPPV Vestibular neuritis HSV oticus Meniere disease Labyrinthine concussion Perilymphatic fistula Semicircular canal dehiscence syndrome Vestibular paroxysma Cogan syndrome Vestibular schwannoma Otitis media Aminoglycoside toxicity Recurrent vestibulopathy | Vestibular migraine Epileptic vertigo Multiple sclerosis Brain tumors Crebellar infarction/hemorrhage Brain stem ischemia Chiari malformation Parkinson | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Hyperventilation Psychiatric symptoms | Balance problem | Sweating Tunnel Vision Nausea Heart palpitations Abdominal discomfort Slurred speech | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Psychogenic dizziness | Dysequilibrium | Presyncope | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
L01 | L02 | L03 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Lee SH, Kim JS (June 2010). "Benign paroxysmal positional vertigo". J Clin Neurol. 6 (2): 51–63. doi:10.3988/jcn.2010.6.2.51. PMC 2895225. PMID 20607044.
- ↑ Chang MB, Bath AP, Rutka JA (October 2001). "Are all atypical positional nystagmus patterns reflective of central pathology?". J Otolaryngol. 30 (5): 280–2. PMID 11771020.
- ↑ Dorresteijn PM, Ipenburg NA, Murphy KJ, Smit M, van Vulpen JK, Wegner I, Stegeman I, Grolman W (June 2014). "Rapid Systematic Review of Normal Audiometry Results as a Predictor for Benign Paroxysmal Positional Vertigo". Otolaryngol Head Neck Surg. 150 (6): 919–24. doi:10.1177/0194599814527233. PMID 24642523.