Morning Report: BPPV

Thanks to Dr. Wang for today’s Morning Report!

Case: 45 year old female with no PMH presents with dizziness. Pt woke up, stood up from bed, and started to feel room-spinning dizziness. Resolved within a few mins. No other symptoms.

BPPV (Benign Paroxysmal Positional Vertigo)

Most common cause of peripheral vertigo in U.S. ~20%.

Onset of BPPV is typically sudden. Many patients wake up with condition and note vertigo while trying to sit up suddenly. Severe dizziness is usually triggered by head movements. Latency and fatigable. Resolves within a few minutes.

Pathophysiology: otholith in posterior semicircular canal.

Dix- Hallpike Maneuver: clinical test for BPPV. 50%-85% sensitive for BVVP.

Patient sitting upright with legs extended. Head is rotated to one side by 45 degrees. Bring the patient quickly to supine position with the head held in approximately 20-30 degree of extension. Observe for nystagmus. Usually 5-10 seconds of latency. Positive if rotatory nystagmus is toward the affected ear.

Treatment:

Watchful waiting

Meclizine

Epley maneuver (canalith repositioning):

Recent EMRap:

Discussed a single site RCT (N 26) compared Epley maneuver vs. medical therapy for symptom reduction of BPPV. Found two are essentially the same.

References:
Li, John. “Benign Paroxysmal Positional Vertigo.” BPPV. Emedicine, 14 Mar. 2014. Web. 5 Aug. 2014. <http://emedicine.medscape.com/article/884261-overview>.

Rabie, Amr. “Canalith-Repositioning Maneuvers.” Canalith- Repositioning Maneuver. Emedicine, 6 Mar. 2014. Web. 5 Aug. 2014.