Positional vertigo gets triggered by a certain critical position of head of the patient. It can be caused by a pathology of central or peripheral component of the vestibular system and nerves. One important thing to diagnose and treat the disease is to find out the site of lesion in the whole pathway. Hallpike maneuver or Dix-Hallpike maneuver helps to differentiate between positional vertigo caused by peripheral pathology (lesion is in the labyrinth or vestibulo-cochlear nerve) from those due to central lesion (in the cetral nervous system).
The following chart clearly shows how to distinguise these two types based on the results of Dix-Hallpike maneuver. A careful observation and knowledge on auditory system physiology and pathology is very important for the diagnosis.
|Latency||The signs start after 2 to 20 seconds of reaching the critical position||Signs start as soon as the critical position is reached|
|Duration||Typically lasts for less than 1 minute||Lasts for as long as the position is maintained|
|Fatigability||Fatigable, i.e. duration reduces on successive attempts to elicit the signs and after sufficient number of times it disappears altogether||Non-fatigable|
|The direction of the nystagmus||Always in one direction (the direction depends on the side affected)||Direction varies according to the test position.|
A. Dix-Hallpike maneuver is also called Hallpike Maneuver, Dix-Hallpike test, Positional test.
B. Peripheral causes of positional vertigo is usually caused by benign paroxysmal positional vertigo
C. Central causes of positional vertigo may be due to multiple sclerosis, vertebrobasilar insufficiency, increased intracranial pressure, or tumor in the fourth ventricle, cerebellum, temporal lobe etc.
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