Benign paroxysmal positional vertigo is an
amazing condition. The reason why is when you see a patient with vertigo you can perform
a manoeuvre which will make the diagnosis. Then you can perform another manoeuvre which
will fix them. When doing the Dix-Hallpike manoeuvre, I always
go through with the patient what I’m about to do. I do this regularly, but to a patient,
this is something that’s very new and it can be a little bit scary for them. Something
I find useful is for the patient to fold their arms before I do the Dix-Hallpike manoeuvre.
The patient’s head is turned 45 degrees towards me. They’re then lowered backwards
so that their head is extended about 20 degrees over the back of the couch.
If a patient has benign paroxysmal positional vertigo, you will often see then within 20
to 30 seconds. Occasionally nystagmus will be seen up to a minute after their head has
been extended. In view of this, if you really do feel that there’s a strong history that
would be suggestive of benign paroxysmal positional vertigo, it’s often worthwhile holding the
head back in the extended position for up to a minute.
When lowering the patient back, if they do have benign paroxysmal positional vertigo,
they can find this very traumatic. If they do find it traumatic they can close their
eyes very tightly. This makes it very difficult to assess any eye movements. To stop patients
from closing their eyes, I explain to them that it’s very important that they keep
their eyes open. Sometimes I ask patients to look at my nose whilst I lower their head
down. It is important to perform the Dix-Hallpike
manoeuvre with the head over the left and right lateral positions. I usually perform
the Dix-Hallpike manoeuvre on the side that is asymptomatic first.