Dix Hallpike test

Dix Hallpike test interpretation.
The most common form of positional nystagmus is the one attributable to BPPV of the posterior canal.During a left ear down head hanging position one triggers a left posterior canal BPPV. The spatial orientation of the canal and the connections between the canals and the ocular motor system determines the characteristics nystagmus. The main component of the nystagmus is a torsional or rotatory nystagmus (these terms are indistinct) beating clockwise from the observer point of view. This means that the upper pole of the patient’s eye will beat towards the patient’s left shoulder. Technically speaking it is left beating torsional nystagmus, as expected from activation of the left posterior canal. A secondary up beating component of nystagmus is often observed which is synchronous with the torsional beat. The nystagmus is often accompanied by intense vertigo and the patients’ attempt to close the eyes or to sit up, for which the doctor will have hopefully instructed them in advance to resist. The characteristics of posterior canal BPPV are the presence of latency, as discussed in the preceding paragraphs, adaptation, and fatigability. Adaptation refers to the decline and eventual disappearance of the nystagmus within a minute or so, usually less. Fatigability refers to the fact that on repeated positioning, the nystagmus and the vertigo are less with time. The patient can be reassured that usually the intensity of the symptoms will be less as we repeat the manoeuvre.
The positional manoeuvre should be conducted on both sides, particularly if no nystagmus is observed on the first side. On confirmation of the diagnosis, these days many specialists proceed directly to the treatment with particle repositioning manoeuvres like the Epley or Semont manoeuvre. Partly because of fears that a new Hallpike after an Epley or Semont manoeuvre could undo the benefits of the treatment, many doctors do not do the Hallpike manoeuvre on the other side if BPPV has been diagnosed and treated on one side. If all symp- toms resolve in the first session that is the end of the story. If symptoms persist the Hallpike manoeuvre will have to be carried out on a separate session on both sides.
Source:
jnnp.bmj.com/c...

[@طبيبةيمنية]

Thank you

[@NEUROLOGYMADEINTERESTING]

You're welcome

[@akshaypatil4480]

Showing rt eye and repeatedly telling left. Gajab

[@NEUROLOGYMADEINTERESTING]

The test is done on left side Dix Hallpike position. Nystagmus develops in both eyes. Right or left can be used for interpretation of findings. Hope you understand now..