Dix Hallpike maneuver (BPPV) Physical Exam Video

Dix Hallpike maneuver:

The Dix Hallpike maneuver or Nylen–Barany test is one of the diagnostic test that is used in patients who present with dizziness. This test is  used to identify benign paroxysmal positional vertigo (BPPV).


This video tutorial on Dix Hallpike Maneuver (BPPV) has been provided by: entukvideo
PROCESS of Dix Hallpike maneuver:
Dix Hallpike maneuver Video tutorial physical exam

  • The Dix Hallpike maneuver is done with the patient sitting in an upright position on the examination table with the legs extended.
  • The patient’s head is then rotated to one side by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension.
  • This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back.
  • The patient’s eyes are then observed for about 45 seconds as there is a characteristic 5–10 second period of latency prior to the onset of nystagmus.
  • If rotational nystagmus occurs then the test is considered positive for benign positional vertigo. During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground. The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise. Home devices are available to assist in the performance of the Dix Hallpike Maneuver for patients with a diagnosis of BPPV.
POSITIVE TEST for Dix Hallpike maneuver:
There are several key characteristics of a positive test:

  • Latency of onset (usually 5–10 seconds)
  • Torsional (rotational) nystagmus. If no torsional nystagmus occurs but there is upbeating or downbeating nystagmus, a central nervous system (CNS) dysfunction is indicated.
  • Upbeating or downbeating nystagmus. Upbeating nystagmus indicates that the vertigo is present in the posterior semicircular canal of the tested side. Downbeating nystagmus indicates that the vertigo is in the anterior semicircular canal of the tested side.
  • Fatigable nystagmus. Multiple repetition of the test will result in less and less nystagmus.
  • Reversal. Upon sitting after a positive maneuver the direction of nystagmus should reverse for a brief period of time.

To complete the test, the patient is brought back to the seated position, and the eyes are examined again to see if reversal occurs. The nystagmus may come in paroxysms and may be delayed by several seconds after the maneuver is performed.

NEGATIVE TEST for Dix Hallpike maneuver:
If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered.

 
References for Dix Hallpike maneuver video tutorial:

  • http://www.youtube.com/watch?v=vRpwf2mI3SU
  • http://en.wikipedia.org/wiki/Dix%E2%80%93Hallpike_test
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