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1、BENIGNPAROXYSMALPOSITIONALVERTIGOWASEEMWATADBasicAnatomyBPPVBarany1921Dix-Hallpike1952–importantfeaturesofnystagmusAbnormalsensationofmotionelicitedbycertaincriticalpositionsProvocativeposition?nystagmusAtleast20%ofvertigoUnderestimatedBPPV…Subclassification:sccpost/lat/ant/bilatPathophys
2、iology:CanalithiasiscupulolithiasisPathophysiologyPathophysiology(cont.)Cupulolithiasis:HaroldSchuknecht1962Densities(otocania)adherenttocupulaofcristaampullarisBasophilicparticles-1969Canalithiasis:JohnEpley–1980DensitiesfreefloatingincanalportionParnes,McClure–1991foundparticlesinpostSC
3、CBPPV...Frequency:10-64/100000Sex:64%womenAge:olderpopulation(51-57)youngerthan35–headtrauma.History:suddendays-weeksoccassionallymonths-yearsepisodes.Physical:neurologicalexamination–normalexcept–Dix-Hallpike?pathognomonicBPPV…Nystagmus:characterizationandtypesRT/LT,vertical/horizontal,c
4、hangingTortional=Rotational–clockwise/counterclockwiseGeotropic-towardtheearthAgeotropic–oppositeBPPV…ClassicpostSCC–geotropicrotatorynystagmusHorizontalSCC–purelyhorizontalnystagmusNon-fatiguingnystagmus–cupulolithiasis>canalithiasisClassicBPPVInvolvedthePOSTSCCGeotropicNGwithaffectedear
5、downRotatory,fastphasetowardtheundermostearLatency–fewsecondsDuration–limited<20secondsReversaluponreturnuprightpositionResponsedeclineuponrepetitiveprovocationLat.SCCPPVMostcommonatypicalBPPV3-9%ofcasesConsequenceofEpleymaneuverHorizontalpurelynystagmusCupulolithiasisratherthancanalithia
6、sisModifiedEpley/lampertmaneuver…Lat.SCCPPVAnt.SCCPPVRare–2%Down-beating/torsionalNGfortheoppositeearonDix-HallpikemaneuverBPPV-CausesPredisposingfactors:InactivityAcutealcoholismMajorsurgeryCNSdiseaseCauses(cont.)Idiopathic–39%Eardisease–29%OM–9%Vestibularneuritis–7%Menier’sdis–7%Otoscle
7、rosis–4%SuddenSNHL–2%Trauma–21%Causes(cont.)Trauma–21%CNSdiseases–11%Acusticneuroma–2%Cervicalvertigo–2%BPPV-D.DMenier’sdiseaseInnerearconcussionAlcoholintoxicationLabyrinthitisVascularloopsyndromePost.Fossalesions:acusticneuroma,meningiomaCentralorigion:stroke,MS,c
