Benign Paroxysmal Positional Vertigo in the Acute Care Setting

Fife, Terry D.; Brevern, Michael von

doi:10.1016/j.ncl.2015.04.003

Cited by 18 publications

(16 citation statements)

References 77 publications

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“…Classical symptoms are repetitive brief, triggered episodes of rotational vertigo lasting less than a minute, though non-vertiginous dizziness is frequent (22,107,108). The diagnosis is confirmed by reproducing symptoms using canal-specific positional testing maneuvers and identifying a canal-specific nystagmus (Table 3) (108–110). We recommend starting with the Dix-Hallpike maneuver, which tests the posterior canal (most commonly involved) (111).…”

Section: A New Diagnostic Paradigmmentioning

confidence: 99%

“…Should the Dix-Hallpike maneuver not reproduce the symptoms, the supine head roll test (where one starts with the patient supine and turns, turning the head to 90 degrees right and left) can be attempted to diagnose horizontal canal BPPV. Once the correct canal is identified, bedside treatment with canal repositioning maneuvers can follow (108). Although BPPV is common, emergency physicians often do not use guideline-supported Dix-Hallpike (diagnostic) or Epley (therapeutic) maneuvers (78,112,113).…”

Section: A New Diagnostic Paradigmmentioning

confidence: 99%

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A New Diagnostic Approach to the Adult Patient with Acute Dizziness

Edlow

Gurley

Newman‐Toker

2018

The Journal of Emergency Medicine

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Background Dizziness, a common chief complaint, has an extensive differential diagnosis that includes both benign and serious conditions. Emergency physicians must distinguish the majority of patients with self-limiting conditions from those with serious illnesses that require acute treatment. Objective of the Review This article presents a new approach to diagnosis of the acutely dizzy patient that emphasizes different aspects of the history to guide a focused physical examination with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes in the emergency department. Discussion Currently, misdiagnoses are frequent and diagnostic testing costs are high. This relates in part to use of an outdated, prevalent, diagnostic paradigm. The traditional approach, which relies on dizziness symptom quality or type (i.e., vertigo, presyncope, or disequilibrium) to guide inquiry, does not distinguish benign from dangerous causes, and is inconsistent with current best evidence. A new approach divides patients into three key categories using timing and triggers, guiding a differential diagnosis and targeted bedside examination protocol: 1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; 2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and 3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. Conclusions The timing and triggers diagnostic approach for the acutely dizzy patient derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreases diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.

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Section: A New Diagnostic Paradigmmentioning

confidence: 99%

Section: A New Diagnostic Paradigmmentioning

confidence: 99%

A New Diagnostic Approach to the Adult Patient with Acute Dizziness

Edlow

Gurley

Newman‐Toker

2018

The Journal of Emergency Medicine

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“…The Gufoni maneuver [7] illustrated is used to treat right-sided horizontal canal benign paroxysmal positional vertigo (BPPV) that is geotropic (A) or apogeotropic (B) in nature. Numbers 1-3 depict the sequential steps in each maneuver.…”

Section: Discussionmentioning

confidence: 99%

Atypical Benign Paroxysmal Positional Vertigo in a Case of Acoustic Neuroma

Carmona¹,

Salazar²,

Zalazar³

2017

JOENTR

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“…Classical symptoms are repetitive brief, triggered episodes of rotational vertigo lasting less than a minute, 105,106 though nonvertiginous dizziness is frequent. 27 The diagnosis is confirmed by reproducing symptoms using canal-specific positional testing maneuvers and identifying a canal-specific nystagmus (►Table 5).…”

Section: Triggered Episodic Vestibular Syndromementioning

confidence: 99%

“…27 The diagnosis is confirmed by reproducing symptoms using canal-specific positional testing maneuvers and identifying a canal-specific nystagmus (►Table 5). [106][107][108][109] Start with the Dix-Hallpike maneuver, which tests the posterior canal (most commonly involved). 110 A detailed recent review of these exam maneuvers includes instructive video clips.…”

Section: Triggered Episodic Vestibular Syndromementioning

confidence: 99%

Acute Dizziness

Edlow

Gurley

2019

Semin Neurol

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Dizziness is a common chief complaint with an extensive differential diagnosis that includes both benign and serious conditions. Physicians must distinguish the majority of patients who suffer from self-limiting conditions from those with serious illnesses that require acute treatment. The preferred approach to the diagnosis of an acutely dizzy patient emphasizes different aspects of the history to guide a focused physical examination, with the goal of differentiating benign peripheral vestibular conditions from dangerous posterior circulation strokes. Currently, misdiagnoses are frequent and diagnostic testing costs are high. This partly relates to use of an outdated diagnostic paradigm. This commonly used traditional approach relies on dizziness “symptom quality” or “type” (vertigo, presyncope, disequilibrium) to guide inquiry. It does not distinguish benign from dangerous causes and is inconsistent with current best evidence. A better approach categorizes patients into three groups based on timing and triggers. Each category has its own differential diagnosis and targeted bedside approach: (1) acute vestibular syndrome, where bedside physical examination differentiates vestibular neuritis from stroke; (2) spontaneous episodic vestibular syndrome, where associated symptoms help differentiate vestibular migraine from transient ischemic attack; and (3) triggered episodic vestibular syndrome, where the Dix-Hallpike and supine roll test help differentiate benign paroxysmal positional vertigo from posterior fossa structural lesions. The “timing and triggers” diagnostic approach for the acutely dizzy derives from current best evidence and offers the potential to reduce misdiagnosis while simultaneously decreasing diagnostic test overuse, unnecessary hospitalization, and incorrect treatments.

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Benign Paroxysmal Positional Vertigo in the Acute Care Setting

Cited by 18 publications

References 77 publications

A New Diagnostic Approach to the Adult Patient with Acute Dizziness

A New Diagnostic Approach to the Adult Patient with Acute Dizziness

Atypical Benign Paroxysmal Positional Vertigo in a Case of Acoustic Neuroma

Acute Dizziness

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