Neuro - Vestibular - Bppv

Front 1

• Which SCCs account for what proportion of BPPV?

• What are the classic symptoms of BPPV?

Back 1

Posterior canal: 76%

Anterior canal: 13%

Horizontal canal: 6%

• True vertigo < 1 minute in length associated with changes in head position, may be accompanied by imbalance, anxiety,
  

Front 2

• What is cupulolithiasis
  
• What is canalithiasis?
  
• How are these distinguishable from each other upon examination?

Back 2

• Dislodged otoconia of otoliths adhere to cupula of SCC
• Dislodged otoconia of otoliths are free-floating within endolymph of SCCs
• B/c free-floating otoconia will sink, symptoms resolve w/in 60 sec; Otoliths adhered to cupula will remain so and continue to pull with gravity >60 sec.

Front 3

• What test is done to assess for anterior or posterior canal BPPV? How is this done?

• What may indicate a central lesion rather than BPPV?

Back 3

• No latency, does not resolve with time or repeat positionnig

Front 4

What constitutes a positive Dix-Hallpike Test?

Back 4

• 1-40 sec latency

• Nystagmus beats towards involved ear and beats up (posterior SCC) or down (anterior SCC); Usually a torsional component is present
• Vertigo increases for a short period
• Both vertigo and nystagmus resolve within 30-60 sec.

Front 5

• What test is an alternative to Dix-Hallpike for pts unable to tolerate 20º extension below horizontal?
  
• What should be assessed?

Back 5

• Side-lying test
• Nystagmus, subjective c/o vertigo

Front 6

What is done to treat anterior or posterior canalithiasis?

• How is it done?

Back 6

Epley maneuver (canalith repositioning)

Front 7

How should patient be instructed following successful canalith repositioning?

Back 7

• Do not sleep on involved side.
  
• Sleep with 1 extra pillow
  
• Avoid extreme head positions
  
• Follow home maneuver for 1-2 days if symptoms are provoked upon lying down with head turned/extended over pillow. Then pt resumes all usual activity.
  

Front 8

• What can be done to promote compensation to vertigo?
  
• How is it prescribed?

Back 8

• Brandt-Daroff Habituation Exercises
  
• 5-20x/day until there are no symptoms of vertigo for 48 hrs

Front 9

What exercise can be used as an alternative to CRT (Epley's) maneuver for posterior canal cupulolithiasis?

Back 9

• Liberatory (Semont) maneuver
• NOTE: posterior cupulolithiasis treated with pt turned away from the involved side
  

Front 10

What exercise can be used for an anterior cupulolithiasis?

Back 10

• Liberatory (Semont) maneuver
  
• NOTE: anterior cupulolithiasis treated with pt turned toward the involved side

Front 11

What test is used to identify horizontal canal BPPV?

• What results indicate canalithiasis?
  
• Cupulolithiasis

Back 11

• Canalithiasis: geotropic, fatigues, more intense direction is impaired side
• Cupulolithiasis: ageotropic, persists, less intense side is impaired side

Front 12

• What is the Bar-B-Que/log roll treatment used for?
  
• How is the log roll best followed up? How is this done?
• How is this changed for a cupulolithiasis?

Back 12

• Horizontal canalithiasis
• F/u with forced prolonged position (FPP); Pt lies in sidelying with affected ear up 8-12 hours
• Same, but with rapid movements

Front 13

What maneuver is an alternative to the Barbeque/Log Roll for horizontal canalithiasis?

Back 13

Appiani (Liberatory) maneuver

Front 14

What maneuver (other than the log roll) may be used to treat horizontal canal cupulolithiasis?

Back 14

Casani maneuver

Front 15

• What 4 post-maneuver instructions should be given to pts with horizontal canal canalithiasis/cupulolithiasis?
  
• For how long should these instructions be followed?

Back 15

1. DO NOT lie on the involved side
2. DO sleep on the uninvolved side
3. DO NOT sleep with an extra pillow
4. Avoid activities requiring increased cervical motion

• Follow instructions 1-2 days, then resume normal activities