Question

A 40-year-old man comes to the OPD with complaints of spinning around him.
What examination would you like to do?

Hint:

The Dix-Hallpike test is a key diagnostic tool for BPPV. A positive test with characteristic nystagmus strongly supports the diagnosis.

Answer 1

Step 1: General Examination.
- Assess the patient's general condition, including vital signs and signs of systemic illness (e.g., fever or signs of infection).
- Check for any signs of neurological deficits such as facial asymmetry, speech difficulties, or limb weakness.

Step 2: Ear Examination.
- Inspect the external ear for any abnormalities (e.g., discharge, swelling, or perforation).
- Perform a tympanic membrane examination to rule out middle ear pathology, such as infection or effusion.

Step 3: Neurological Examination.
- Dix-Hallpike Maneuver: This is the hallmark test for diagnosing BPPV. It involves rapidly moving the patient's head from a sitting position to a supine position with the head tilted 45 degrees to each side, observing for nystagmus.
- Head Impulse Test: This test evaluates the function of the vestibular system. The examiner rapidly turns the patient's head in one direction and observes for corrective saccadic eye movements, which would indicate a vestibular abnormality.
- Romberg Test: Ask the patient to stand with feet together and eyes closed. A positive Romberg sign (loss of balance) indicates proprioceptive or central vestibular dysfunction.
- Neurological Testing: Perform cranial nerve examination, gait assessment, and coordination tests (e.g., finger-nose test) to rule out central causes such as a stroke or MS.

Step 4: Conclusion.
A detailed examination with a focus on vestibular function helps to differentiate between peripheral and central causes of vertigo. The Dix-Hallpike maneuver is particularly useful in diagnosing BPPV.