Benign

paroxysmal ALSANGEDY
positional vertigo
BULLETS
 Problem in the inner
ear FOR PACES
 Vertigo FOR EASY PASSING PACES FROM
THR 1ST ATTEMPT
 Vomiting is common Dr. Ibrahim Alsangedy
MRCP-UK
 Nausea is often
MRCPE
associated.
 Paroxysmal
 Sudden onset of
episodes with a short
duration: lasts only
seconds to minutes.
 Positional Can be
induced by a change ALSANGEDY B ULLETS FOR PACES
in position.
 Pre-syncope or
syncope is unusual
but possible.
 Rotatory nystagmus,
the top of the eye
rotates towards the
affected ear
 Visual disturbance.
Cause
 In patients with BPPV, the
otoconia are dislodged from their
usual position within the utricle,
and migrate over time into one of
the semicircular canal
 When the head is reoriented
relative to gravity, the gravity-
dependent movement of the
heavier otoconial debris within
the affected semicircular canal
causes abnormal endolymph fluid
displacement and a resultant
sensation of vertigo.
Mechanism
Diagnosis
 Diagnosis is largely based on
patient description and history
 The Dix–Hallpike test
Differential Diagnosis
 Motion sickness/ intolerance
 Visual exposure to nearby
moving objects
 Labyrinthitis
 Ménière's disease
 Migraine
ALSANGEDY BULLETS FOR PACES
isangedy@gmail.com
00965 69691034
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from the 1st attempt
Facebook group: - MRCP PACES
from the 1st attempt
 The vestibular labyrinth includes
semicircular canals, which
contain fluids and fine hairlike
sensors which act as a monitor to
the rotations of the head.
 An important structure in the
inner ear called the otolith
organs which contain crystals
that are sensitive to gravity.
 These crystals are responsible
for sensitivity to head positions,
and can also be dislocated,
causing them to lodge inside one
of the semicircular canals, which
causes dizziness.
Management
 Repositioning maneuvers:
 Epley maneuver: The Epley
maneuver employs gravity
to move the calcium crystal
build-up that causes the
condition
 Semont maneuver: has a
cure rate of < 90%
 The Brandt–Daroff exercises may
be prescribed as a home
treatment method
 Roll maneuver For the lateral
(horizontal) canal
 Meclizine, hyoscine butylbromide
and betahistine
 Surgical treatments, such as a
semi-circular canal occlusion, do
exist for BPPV, but carry the same
risk as any neurosurgical
procedure