Active head rotation in benign positional paroxysmal vertigo

Abstract

Beni gn Positional Paroxysmal Vertigo (BPPV) is one of the most common vestibular diseases and the active head rotation test one of the most modern methods of vestibular function assessment. Aim: this study aims to verify if the active head rotation test may reveal signs of horizontal and/or vertical vestibulo-ocular reflex dysfunction in vertigo patients suspected for BPPV. Study design: retrospective series study. Materials and Method: Neurotological evaluation including computerized electronystagmography and active head rotation on the horizontal and vertical axes were conducted in 100 patients suspected for BPPV patients. Results: Isolated or associated abnormalities of the horizontal and/or vertical vestibulo-ocular reflex gain, phase and symmetry were indicative of vestibular involvement and found in 77.0% of the BPPV patients. Conclusion: the active head rotation test revealed horizontal and/or vertical vestibulo-ocular reflex dysfunctions in a relevant number of BPPV patients.

Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE‐3): Acute dizziness and vertigo in the emergency department

“…The benefits of treating patients with pc‐BPPV with a bedside therapeutic maneuver are large given the very small NNT. The primary benefits are decreased patient symptoms with potential subsequent fall and injury reduction 261,262 . In addition, earlier treatment with an Epley maneuver in the ED may be more effective than later treatment that would result from referral, 76 and reduce the frequency of recurrences, 74 further supporting performing the Epley maneuver in the ED at the time of diagnosis.…”

“…The primary benefits are decreased patient symptoms with potential subsequent fall and injury reduction. 261,262 In addition, earlier treatment with an Epley maneuver in the ED may be more effective than later treatment that would result from referral, 76…”

“…Earlier treatment with an Epley maneuver is more effective than later treatment 76 and can reduce the incidence of falls. 259,261,262 A systematic review on this subject recommends against using vestibular suppressants. 264 If one were to use a vestibular suppressant, a recent systematic review found that single-dose antihistamines were more effective than single-dose benzodiazepines at reducing vertigo at 2 h after administration.…”

Epley maneuver for benign paroxysmal positional vertigo: Evidence synthesis for guidelines for reasonable and appropriate care in the emergency department

“…69,70 Treatment of BPPV with Epley in older adults, the most likely population to have the disease and be negatively affected by the sensation of imbalance, decreases their risk of subsequent falls by more than half. 71 In fact, earlier treatment (within 24 h of symptom onset) cuts the recurrence rate in half 72 and increases the likelihood of resolution. 73 For all these reasons, prompt treatment in the ED is important.…”

Benign paroxysmal positional vertigo: A practical approach for emergency physicians

“…Another reason to treat patients with BPPV is that they are at an increased risk for falls with resultant injuries, 20,41–43 especially in the elderly. Treatment reduces fall frequency 43,44 . Other reasons to treat early are that delayed treatment (beyond 24 h compared to before 24 h) more than doubled the rate of BPPV recurrences in a study of 138 patients 45 and that delayed Epley maneuvers can become less effective with time 46 …”