[Management of bilateral benign paroxysmal positional vertigo with Dix-Hallpike test]

Fei Zhao, Jianhua Zhuang, Xuewei Xie, Zhe Jin, Ying Chen, Zhongxin Zhao
Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine] 2014, 53 (10): 764-7

OBJECTIVE: To explore the diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) with bilateral positive Dix-Hallpike test.

METHODS: This is a retrospective study based on the clinical data of BPPV patients diagnosed in the Dizziness Clinic of Changzheng Hospital from January 2012 to December 2012. Totally 490 patients with vertigo and nystagmus provoked by Dix-Hallpike maneuver were included in the present analysis.

RESULTS: Among all the patients, 55 (11.2%) of them presented with bilateral nystagmus by the provocative test. According to the type of nystagmus provoked by Dix-Hallpike maneuver, the 55 patients can be divided into the following four categories. (1) Bilateral geotropic (n = 16) and apogeotropic nystagmus (n = 5): all these patients were diagnosed with horizontal canal BPPV and free of vertigo after head side-shaking exercise in supine position and Barbecue maneuver. (2) Bilateral predominant down-beating nystagmus (n = 2): patients in this group were diagnosed with anterior canal BPPV, and got recovered after Kim maneuver. (3) Bilateral torsional up-beating geotropic nystagmus (n = 20): after a lying-down test, 6 of the patients manifested as vertical up-beating nystagmus and 14 patients remained torsional up-beating nystagmus. The former were diagnosed with bilateral posterior canal BPPV, and were cured after bilateral PRM therapy, and the latter were diagnosed with horizontal canal BPPV, who were cured after Barbecue maneuver. (4) Torsional up-beating geotropic nystagmus on one side and down-beating nystagmus on the other side (n = 12). The down-beating nystagmus on the other side disappeared when the patients was firstly seated up with head down in 30 degrees for half an hour before second Dix-Hallpike maneuver. These patients were diagnosed with unilateral posterior canal BPPV and cured by PRM therapy.

CONCLUSIONS: It is common for vertigo patients with bilateral nystagmus induced by Dix-Hallpike test. The diagnoses should be made by the types of nystagmus provoked step by step before maneuver therapy.

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