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Vertigo epley maneuver videos4/6/2024 North American Neuro-Ophthalmology Society Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: Examination features in this case that reassure the examiner that they are dealing with BPPV (as opposed to a central positional nystagmus variant) include the following: fatigability (not shown here, but with repetitive Dix-Hallpike maneuvers, the vertigo and nystagmus become less and less prominent) a brief latency between Dix-Hallpike and the onset of vertigo/ nystagmus (as the otoconia moves to the most dependent part of the canal during Dix-Hallpike, it drags the endolymph with it, and this endolymph flow deflects the cupula causing vestibular excitation- because deflection of the cupula does not occur instantaneously during the Dix-Hallpike, a brief latency is the consequence) a crescendodecrescendo nystagmus the expected pattern of nystagmus is observed given the laterality of the specific Dix-Hallpike maneuver performed (e.g., right Dix-Hallpike produces nystagmus with an upbeat component and with a torsional component, with the top poles beating toward the lowermost/ affected ear) vertigo and nystagmus respond to properly performed repositioning (Epley or other) maneuvers. At that point, the maneuver did not provoke nystagmus and vertigo, demonstrating that the Epley maneuver had been successful in moving the otoconia out of the right posterior canal. The patient was then treated with an Epley maneuver, and was later rechecked with the right Dix-Hallpike maneuver. Examination features in this case that reassure the examiner that they are dealing with BPPV (as opposed to a central positional nystagmus variant) include the following: fatigability (not shown here, but with repetitive Dix-Hallpike maneuvers, the vertigo and nystagmus become less and less prominent) a brief latency between Dix-Hallpike and the onset of vertigo/nystagmus (as the otoconia moves to the most dependent part of the canal during Dix-Hallpike, it drags the endolymph with it, and this endolymph flow deflects the cupula causing vestibular excitation - because deflection of the cupula does not occur instantaneously during the Dix-Hallpike, a brief latency is the consequence) a crescendo-decrescendo nystagmus the expected pattern of nystagmus is observed given the laterality of the specific Dix-Hallpike maneuver performed (e.g., right Dix-Hallpike produces nystagmus with an upbeat component and with a torsional component, with the top poles beating towards the lowermost/affected ear) vertigo and nystagmus respond to properly performed repositioning (Epley or other) maneuvers. The patient was then treated with an Epley maneuver (see for an example), and was later rechecked with the right Dix-Hallpike maneuver. When the patient was moved into the right Dix-Hallpike maneuver, after a brief latency, upbeat-torsional (towards the lowermost or affected ear) nystagmus was seen. □□□□□□□□ □□□□□□□□□□□: This is a patient with typical right posterior canal benign paroxysmal positional vertigo (BPPV), which was provoked by the Dix-Hallpike maneuver. (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland (DN) University of Siena, Siena, Italy (MM) Otology and Skull Base Unit Azienda Ospedaliera Universitaria Senese, Siena, ItalyīPPV Posterior BPPV Diagnosis BPPV Treatment Jerk Nystagmus Vestibular Nystagmus Gold, DO Daniele Nuti Marco Mandal, MD, PhD Video 6.22 Posterior canal BPPV-nystagmus provoked by the Dix-Hallpike maneuver from Neuro-Ophthalmology and Neuro-Otology Textbookĭaniel R. Posterior Canal BPPV Pre- and Post-Epley Maneuver
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