Question

A 40-year-old man comes to the OPD with complaints of spinning around him.
What is BPPV, and how will you manage it?

Hint:

The Epley maneuver is the most effective treatment for BPPV. It is highly successful in resolving symptoms and should be performed under supervision initially.

Answer 1

Step 1: Understanding BPPV.
Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of vertigo, resulting from the displacement of calcium carbonate crystals (otoliths) in the semicircular canals, typically the posterior canal. This leads to abnormal stimulation of the vestibular system, causing a sudden sensation of spinning when the head is moved in certain positions.
- The hallmark symptom is brief episodes of vertigo triggered by positional changes (e.g., turning in bed, looking upward).

Step 2: Diagnosis of BPPV.
- Dix-Hallpike Maneuver: This diagnostic test induces vertigo and characteristic nystagmus when the head is positioned in certain ways. The nystagmus typically lasts for less than a minute and is indicative of BPPV.

Step 3: Management of BPPV.
- Repositioning Maneuvers: The first-line treatment for BPPV is repositioning maneuvers, such as the Epley maneuver, which involves a series of head movements designed to move the otoliths from the semicircular canals back to the utricle, where they no longer cause symptoms.
- Brandt-Daroff Exercises: These are exercises that patients can perform at home to help resolve symptoms of BPPV by habituating the vestibular system.
- Symptomatic Treatment: Antihistamines or benzodiazepines may be used to relieve acute symptoms, but they are not recommended for long-term management.
- Follow-Up: Most patients respond well to repositioning maneuvers, but some may require repeated treatments. Patients should be reassured that BPPV is a benign condition.

Step 4: Conclusion.
BPPV is a benign condition that can be effectively managed with repositioning maneuvers such as the Epley maneuver. Symptomatic treatment and follow-up are also important in managing this condition.