QuestionSBA
QuestionChoice
This woman describes vertigo and dizziness on sudden head movements characteristic of benign paroxysmal positional vertigo, for which Dix-Hallpike is diagnostic.
10015881
a
Dix-Hallpike manoeuvre
QuestionChoice
This may be useful to assess the extent of degenerative changes within the knee or characterise any ligamentous or soft tissue injury however the fall does not seem related to the OA and her gait is normal.
10015884
d
MRI Knee
QuestionChoice
This may prove useful if suspecting a stroke secondary to carotid artery stenosis but as per the explanation for why non contrast CT head was not correct, it is not the best choice in this case.
10015885
e
Carotid artery doppler
QuestionChoice
This may be useful to assess for C-spine fracture in trauma or to assess whether cervical myelopathy caused the fall. Degenerative Cervical myelopathy would have more likely caused sensory changes and loss of fine motor function of the hands.
10015882
b
CT Cervical Spine
QuestionChoice
This would be diagnostic for a stroke, for which she has vascular risk factors for. However the absence of focal neurology and the fact that symptoms occur on head turning point away from stroke.
10015883
c
Non-contrast CT head
QuestionComment
where does it say she is having vertigo??
34990
QuestionComment
Dizzy when tying shoelaces i.e. vertigo triggered by change in head position, which is characteristic of BPPV
35140
User
subscriber
Biopsy Otitis
QuestionComment
to be pedantic, the answer says "She describes vertigo and dizziness...", implying these are seperate symptoms not interchangeable terms, though she also feels "the room spinning".

Overall, I still agree with @BO that this was [clumsily?]  intended to highlight vertigo  
50769
User
subscriber
Pudendal Gastro
User
subscriber
Kawasaki Serotonin
QuestionComment
is this not a correct investigation for vertebrobasilar insufficiency which would make sense with the history and the specific head movement? 
57613
User
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users1907329
QuestionComment
Dix-hallpike - for Diagnosis (D) 
Epley for treatment (if anyone else can't remeber which is which for BPPV)
60968
User
subscriber
Haemolytic antibody
QuestionComment
BUT SHE HAD A FALL WHY>>>>>
61101
User
subscriber
Liver Hallux
Concept
Chapter
# Summary

Benign Paroxysmal Positional Vertigo (BPPV) is a condition characterised by sudden episodes of vertigo, typically following head movement. It is the most common cause of vertigo, particularly in the elderly due to calcium deposition within the semicircular canals. The key signs and symptoms include sudden attacks of rotational vertigo lasting for 30 seconds to 1 minute, triggered by changing head positions. There are no associated auditory symptoms. Diagnosis is made using the Dix-Hallpike manoeuvre, and management primarily involves the Epley manoeuvre. 

# Definition

Benign Paroxysmal Positional Vertigo (BPPV) is a medical condition characterised by sudden, episodic attacks of vertigo induced by changes in head position. This condition is due to detachment of otoliths in the inner ear, which results in hair cell stimulation and subsequent vertigo symptoms.

# Epidemiology

BPPV is the leading cause of vertigo and is especially prevalent within the elderly population. This increased prevalence is largely attributed to the accumulation of calcium deposits, known as cholelithiasis, within the semicircular canals of the inner ear.

# Aetiology

BPPV arises due to a detachment of otoliths from the utricle of the inner ear. These detached particles can migrate into the semicircular canals, where they stimulate hair cells and lead to symptoms of vertigo.

# Signs and Symptoms

Key clinical features of BPPV include:

- Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards
- Episodes of rotational vertigo lasting between 30 seconds to 1 minute
- Absence of auditory symptoms
- Recurrent episodes, often resolving naturally over weeks to months

# Differential Diagnosis

Differential diagnoses for BPPV include other conditions that can cause vertigo such as Meniere's disease, vestibular neuritis, and labyrinthitis. Key signs and symptoms for these conditions include:

- Meniere's disease: episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the ear
- Vestibular neuritis: sudden onset of severe vertigo, nausea, and imbalance lasting for several days
- Labyrinthitis: vertigo, hearing loss, and tinnitus

# Investigations

The primary diagnostic test for BPPV is the Dix-Hallpike manoeuvre. This test involves a series of specific head movements that provoke the characteristic vertigo and nystagmus associated with BPPV.

[Click here for more information](https://www.thebsa.org.uk/wp-content/uploads/2014/04/HM.pdf)

# Management

The mainstay of BPPV management is the Epley manoeuvre. This therapeutic manoeuvre aims to move the detached otoliths out of the semicircular canal and back to the utricle where they originate.

[Click here for more information](https://www.racgp.org.au/download/Documents/AFP/2013/January/February/201301handi.pdf)

# References

[Click here for NICE CKS on benign paroxysmal positional vertigo](https://cks.nice.org.uk/topics/benign-paroxysmal-positional-vertigo/)
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Benign paroxysmal positional vertigo (BPPV)
Topic
24
Ear, Nose & Throat
Condition
92
Benign paroxysmal positional vertigo
UkmlaTopic
9
Ear, nose and throat
Condition
93
Benign paroxysmal positional vertigo
UkmlaTopic
12
General practice and primary healthcare
Condition
94
Benign paroxysmal positional vertigo
UkmlaTopic
14
Medicine of older adult
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Suspected Benign Paroxysmal Positional Vertigo (BPPV) should be diagnosed through performing the Dix-Hallpike manoeuvre.
Presentation
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Dizziness
UkmlaTopic
4
Cardiovascular
Presentation
210
Dizziness
UkmlaTopic
9
Ear, nose and throat
Presentation
211
Dizziness
UkmlaTopic
12
General practice and primary healthcare
Presentation
212
Dizziness
UkmlaTopic
14
Medicine of older adult
Presentation
213
Dizziness
UkmlaTopic
17
Neurosciences
A 78-year-old woman was brought in by ambulance following a fall at home. She describes recently feeling unsteady on her feet and dizzy with the room spinning, when tying her shoelaces. She has hypertension, type 2 diabetes, knee osteoarthritis and COPD. On examination, her gait and balance were normal, with no focal neurology.

Which of the following is likely to diagnose the underlying cause of her fall?
a