BPPV良性發(fā)作性位置性眩暈

1、BPPV良性發(fā)作性位置性眩暈Basic AnatomyBPPVBarany 1921Dix-Hallpike 1952 important features of nystagmus Abnormal sensation of motion elicited by certain critical positionsProvocative position nystagmusAt least 20% of vertigoUnderestimated BPPV Subclassification : scc post/lat/ant/bilatPathophysiology :Canalithi

2、asiscupulolithiasisPathophysiologyPathophysiology (cont.)Cupulolithiasis : Harold Schuknecht 1962 Densities (otocania) adherent to cupula of crista ampullarisBasophilic particles -1969Canalithiasis :John Epley 1980Densities free floating in canal portionParnes , McClure 1991 found particles in post

3、SCC BPPV .Frequency : 10-64/100000Sex : 64% womenAge : older population ( 51-57) younger than 35 head trauma.History : sudden days-weeksoccassionally months -years episodes.Physical : neurological examination normal except Dix-Hallpike pathognomonicBPPV Nystagmus : characterization and types RT / LT

4、 , vertical / horizontal , changingTortional = Rotational clockwise / counterclockwiseGeotropic- toward the earthAgeotropic oppositeBPPV Classic post SCC geotropic rotatory nystagmusHorizontal SCC purely horizontal nystagmusNon-fatiguing nystagmus cupulolithiasis canalithiasisClassic BPPVInvolved th

5、e POST SCC Geotropic NG with affected ear downRotatory , fast phase toward the undermost earLatency few secondsDuration limited 6 procedures in 2 weeks , should considering liberatory maneuverElderly population and BPPVS. Angeli 2003 :Effectiveness of CRP and VRModified Epley :Elderly comorbidities

6、: degenerative osteoarthritis disease , CVA , peripheral neuropathy, cognitive and autonomic dysfunctionsS/E of CRP neck torsion and extension result in vertibrobasilar artery insufficiency, strain on the spine column, dislodged carotid a. emboliAvoid liberatory maneuver 64% CRP group negative DH af

7、ter a month Overall 77% with CRP and VRCRP Meta-Analysis B. Woodworth - 2004CRP - First line of treatmentNon-invasiveEasy to perform in the officeNo need to expensive instrumentationsRepeat maneuver if neededPotential to provide rapid relief of vertigo Meta - Analysis9 randomized-controlled trials S

8、ymptoms resolution and elimination of positive Dix-Hallpike testCRP more effective than control ( x5 )Untreated patients - symptoms improvements with time but positive DHSo Resolution of vertigo avoidance of provocative positions CRP Epley maneuverCRP Semont maneuverMastoid oscillatorBrandt-Daroff ExserciseLampert maneuver- Lat. SCC BPPVVestibular rehabilitaionsComplications