1. Diagnosis and Therapy in Benign Paroxysmal Positional Vertigo (BPPV) Dr. Nadir Ali Syed Head, Section of Neurology Aga Khan University

2. Introduction to BPPV Pathophysiology of most BPPV History and physical exam Canalith repositioning therapy

3. Introduction: BPPV is a peripheral vestibular disorder causes spells of vertigo that last less than 1 minute when the patient moves their head. 1 in 4 people will suffer it at some time during their lifetime It is now a readily treatable condition

4. Introduction to BPPV Pathophysiology of most BPPV History and physical exam Canalith repositioning therapy

9. Introduction to BPPV Pathophysiology of most BPPV History and physical exam Canalith repositioning therapy

10. History Patients complain of vertigo that usually goes away in a few seconds to a minute if they do not move their head again. often occurs in the morning when they get up or turn over in bed poor balance may last for several hours after a bout of positional vertigo.

11. Poor balance57% Sense of rotation53% Trouble walking48% Lightheadedness42% Nausea35% Sense of tilt24% Sweating22% Sense of floating22% Blurred vision15% Frequency of complaints in patient with BPPV from standardized questionnaire

12. Physical Exam Diagnosis of BPPV is secured by eliciting nystagmus and vertigo after the head is moved in the plane of one of the SCC Bedside tests to diagnose BPPV: Dix-Hallpike Test

13. Introduction to BPPV Pathophysiology of most BPPV History and physical exam Canalith repositioning therapy

14. Canalith Repositioning Therapy (CRT) for posterior SCC BPPV It is effective in 85-95% of patients with one treatment Epley, 1992, 1996, Herdman et al, 1993, Weider et al, 1994, Welling et al, 1994, Fung et al, 1996,

15. Treatment of posterior SCC BPPV Therapy is based on treatments that move the otoconia in the SCC back to the utricle. Once it is in this location it is reabsorbed into the macule of the utricle. Medication is not indicated, as this is a mechanical problem. there is no treatment that can prevent the recurrence of the release of particles from the utricle to the SCC.

19. Summary Posterior and anterior semicircular canal BPPV comprises majority of BPPV, and may be treated effectively by CRT. THE END Acknowledgments: David Solomon, Ronald J. Tusa Michael C. Schubert, Terry D. Fife American Academy of Neurology Massachusetts Medical Society