Neurologic Manifestations of Benign Positional Vertigo Workup

  • Author: John C Li, MD; Chief Editor: Robert A Egan, MD   more...
 
Updated: Apr 10, 2012
 

Laboratory Studies

Since the Dix-Hallpike test is pathognomonic, laboratory tests are not required to make the diagnosis of benign paroxysmal positional vertigo. However, keep in mind that since benign paroxysmal positional vertigo is strongly associated with inner ear disease, lab workup might be needed to delineate other associated conditions.

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Imaging Studies

If objective abnormalities are confirmed in the general physical or neurologic examination, or clinical history warrants it, strong consideration should be given to obtaining neuroimaging (ie, MRI of the brain) with particular attention to the brain stem and posterior fossa structures.

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Other Tests

  • Electronystagmography (ENG): Torsional eye movement cannot be demonstrated directly. Occasionally ENG is helpful in detecting the presence and timing of nystagmus.
  • Caloric test can be normal or hypofunctional (unpublished data, personal communication from Mohammed Hamid, MD).
    • Vestibular response can be reduced secondary to the sluggishness of the particle-laden endolymph.
    • Benign paroxysmal positional vertigo can originate in the ear with an absent caloric response because the nervous and vascular supply to the horizontal canal is separate from that of the posterior semicircular canals.
  • Infrared nystagmography: Torsional eye movement can be demonstrated directly.
  • Audiogram: Findings may be normal.
  • Posturography: Findings are often abnormal but follow no predictable or diagnostic pattern.
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Contributor Information and Disclosures
Author

John C Li, MD  Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Neurotology Society, American Tinnitus Association, Florida Medical Association, and North American Skull Base Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Spiros Manolidis, MD  Associate Professor of Otolaryngology and Neurological Surgery, Columbia University

Spiros Manolidis, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Auditory Society, American Head and Neck Society, American Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, Society of University Otolaryngologists-Head and Neck Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed  Director, Regional MS Center of Excellence, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, and Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, and Oregon Medical Association

Disclosure: Nothing to disclose.

References

  1. Boniver R. Benign paroxysmal positional vertigo: an overview. Int Tinnitus J. 2008;14(2):159-67. [Medline].

  2. Epley JM. The canalith repositioning procedure for treatment of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1992;107(3):399-404. [Medline].

  3. Parnes LS, McClure JA. Posterior semicircular canal occlusion in the normal hearing ear. Otolaryngol Head Neck Surg. Jan 1991;104(1):52-7. [Medline].

  4. Li JC, Epley J. The 360-degree maneuver for treatment of benign positional vertigo. Otol Neurotol. Jan 2006;27(1):71-7. [Medline].

  5. Weider DJ, Ryder CJ, Stram JR. Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley. Am J Otol. May 1994;15(3):321-6. [Medline].

  6. Roberts RA, Gans RE, DeBoodt JL, Lister JJ. Treatment of benign paroxysmal positional vertigo: necessity of postmaneuver patient restrictions. J Am Acad Audiol. Jun 2005;16(6):357-66. [Medline].

  7. Prokopakis EP, Chimona T, Tsagournisakis M, et al. Benign paroxysmal positional vertigo: 10-year experience in treating 592 patients with canalith repositioning procedure. Laryngoscope. Sep 2005;115(9):1667-71. [Medline].

  8. Lynn S, Pool A, Rose D, et al. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg. Dec 1995;113(6):712-20. [Medline].

  9. Li JC. Mastoid oscillation: a critical factor for success in canalith repositioning procedure. Otolaryngol Head Neck Surg. Jun 1995;112(6):670-5. [Medline].

  10. Li JC, Li CJ, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg. Mar 2000;122(3):334-9. [Medline].

  11. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. Nov 2008;139(5 Suppl 4):S47-81. [Medline].

  12. Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1980;88:599-605. [Medline].

  13. Herdman SJ, Tusa RJ, Zee DS, et al. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. Apr 1993;119(4):450-4. [Medline].

  14. Schuknecht HF. Cupulolithiasis. Arch Otolaryngol. Dec 1969;90(6):765-78. [Medline].

 
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The steps involved in performing left-sided canalith repositioning procedure (CRP). The head is positioned 30 degrees toward the affected ear (left ear in this example). Next it is brought gently back to a reclining position. Note how the labyrinthine particles gravitate.
Continuation of the canalith repositioning procedure (CRP). Once supine, the head is rotated 180 degrees (ie, away from the affected side).
Another view of the canalith repositioning procedure treating the left ear.
 
 
 
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