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{{familytree | |!| | | D02 | | D00 | {{familytree | |!| | | D02 | | D00 | | | D03 | | | | | | D04 |D02=Sweating?<br>Heaviness sensation in the legs?<br>"Tunnel" vision?<br>Feeling warm or hot?<br>Nausea?<br>Vomiting?|D00=History of seizure<br>Aura<br>Post-ictal phase<br>Uncontrollable muscle spasms<br>Drooling or frothing at the mouth<br>Teeth clenching<br>Tongue biting<br>Sudden, rapid eye movements|D03=Yes|D04=No}} | ||
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{{familytree | E01 | | E02 | | E00 | {{familytree | E01 | | E02 | | E00 | | | E03 | | | | | | |!| |E01=Other|E02=Syncope|E00=Seizure|E03=Vertigo}} | ||
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{{familytree | {{familytree | | | | | | | | | | | | | | F02 | | | | | | |!| |F01=F01|F02=Sudden onset?<br>Horizental vertigo?<br>Auditory symptoms?<br>No neurological problem?}} | ||
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{{familytree | {{familytree | | | | | | | | | | | | I01 | | I02 | | | | |!| | | | | | | |I01=BPPV<br>Vestibular neuritis<br>HSV oticus<br>Meniere disease<br>Labyrinthine concussion<br>Perilymphatic fistula<br>Semicircular canal dehiscence syndrome<br>Vestibular paroxysma<br>Cogan syndrome<br>Vestibular schwannoma<br>Otitis media<br>Aminoglycoside toxicity<br>Recurrent vestibulopathy|I02=Vestibular migraine<br>Epileptic vertigo<br>Multiple sclerosis<br>Brain tumors<br>Crebellar infarction/hemorrhage<br>Brain stem ischemia<br>Chiari malformation<br>Parkinson}} | ||
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{{familytree | {{familytree | | | | | | | | | | | | | | | | | | J01 | | J02 | | | | J03 |J01=Hyperventilation<br>Psychiatric symptoms|J02=Balance<br>problem|J03=Sweating<br>Tunnel Vision<br>Nausea <br>Heart palpitations <br>Abdominal discomfort<br>Slurred speech}} | ||
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Revision as of 16:17, 7 March 2019
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 |
---|---|
History |
|
Physical exam |
|
Diagnostic approach
Patient present with dizziness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Loss of consciousness? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Sense of motion/ spinning? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | Syncope | Seizure | Vertigo | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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.