Contributor: Aaron Lessen, MD
Educational Pearls:
Benign Paroxysmal Positional Vertigo (BPPV)
-
Common inner ear condition that can cause dizziness
-
Diagnosis of BPPV can help to avoid admissions and extra imaging
-
Three categories: positional, horizontal, and anterior
-
Positional is the most common
-
Dizziness is not a positive indicator, a torsional nystagmus must be induced
-
Dix’s hallpike maneuver is done to diagnose and an epley maneuver is then used for treatment
-
Horizontal
-
Usually determined to be the case if the vertigo seems positional and the dix hallpike does not work. A supine roll test would then be done to help diagnose.
-
Instead of a rotational nystagmus, a one-sided horizontal nystagmus is expected in order to determine a positive indicator
-
Down-beating nystagmus is determined to be geotropic and is treated by a barbeque roll maneuver. While upbeating nystagmus is apogeotropic and is treated by Gufoni maneuver.
-
Anterior is more rare
-
Most cases require neuro consults
-
Determined by attempting to induce a down-beating nystagmus, which is a more concerning nystagmus.
-
Treatment is tilting their head back up in a similar way
-
Inducing the nystagmus is not sided and is more central
References
-
Kim DY, et al. Evaluation and management of blunt cerebrovascular injury: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020.
-
Biffl WL, et al. Screening for and treatment of blunt cerebrovascular injuries: Western Trauma Association critical decisions algorithm. J Trauma. 2009.
-
Brommeland T, et al. Best practice guidelines for blunt cerebrovascular injury. Scand J Trauma Resusc Emerg Med. 2018.
-
Harper PR, et al. Routine CTA screening identifies blunt cerebrovascular injuries missed by clinical risk factors. Trauma Surg Acute Care Open. 2022.
Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P
Donate: https://emergencymedicalminute.org/donate/
Join our mailing list: http://eepurl.com/c9ouHf