How to Do Dix Hallpike Maneuver for Dizziness
The Dix Hallpike maneuver is one of the diagnostic test that is used in patients who present with dizziness.
- Vertigo is a strong sense of motion or spinning, often triggered by moving your head too quickly.
- Lightheadedness is feeling woozy or disconnected from environment.
- Disequilibrium is feeling off-balance, unsteady or wobbly.
- Pre-syncope is a feeling of losing consciousness or about to be fainting.
Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo, accounting for nearly one-half of patients with peripheral vestibular dysfunction. It is most commonly attributed to calcium debris within the posterior semicircular canal, known as canalithiasis. While symptoms can be troublesome, the disorder usually responds to treatment with particle-repositioning maneuvers, an office-based procedure and one that patients can be taught to perform at home.
Dix Hallpike maneuver is a group of positional maneuvers are designed to produce vertigo and elicit nystagmus in patients with a history of positional dizziness. These maneuvers are most useful in patients who do not have symptoms or nystagmus at rest and whose vertigo is episodic. The Dix Hallpike maneuver tests for canalithiasis of the posterior semicircular canal, which is the most common cause of BPPV.
The Dix Hallpike maneuver will usually provoke paroxysmal vertigo and nystagmus if posterior canal dysfunction is present in the lower ear. The nystagmus and vertigo usually appear after a latency of a few seconds and last less than 30 seconds. It has a typical trajectory, beating upward and torsionally, with the upper poles of the eyes beating toward the ground. After the patient sits up, the nystagmus will recur but in the opposite direction.
The maneuver should be repeated to the same side; with each repetition the intensity and duration of nystagmus will diminish, confirming the fatigable nature of the phenomenon. However, repetition of the maneuver can interfere with the ability to immediately perform a therapeutic particle repositioning maneuver; repetition may be deferred when this is being considered.
How to Do Dix Hallpike Maneuver
1. With the patient sitting, the neck is extended and turned to one side (panel A).
2. The patient is then placed supine rapidly, so that the head hangs over the edge of the bed, still turned to the side.
3. The patient is kept in this position and observed for nystagmus for 30 seconds.
In patients with benign paroxysmal positional vertigo affecting the posterior canal, nystagmus usually appears with a latency of a few seconds and lasts less than 30 seconds. It has a typical trajectory, beating upward and torsionally, with the upper poles of the eyes beating toward the ground.
If the test is positive, the affected semicircular canal is the side to which the head is turned in step 1.
4. After symptoms and nystagmus stop, the patient sits up.
5. The patient is again observed for nystagmus for 30 seconds.
In patients with benign paroxysmal positional vertigo, the nystagmus may recur but in the opposite direction.
6a. If nystagmus is provoked, the patient should have the maneuver repeated to the same (provoked) side; with each repetition, the intensity and duration of nystagmus will diminish. Testing of the other side is unnecessary.
6b.If nystagmus is not provoked, the maneuver is repeated with the head turned to the other side (panel B).
6c. If nystagmus is still not provoked, other subtypes of benign paroxysmal positional vertigo can be tested by appropriate maneuvers.
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