A7. Dix-Hallpike and Halmágyi-manoeuvre, alternation cover test and Epley – reposition manoeuvre

From greek.doctor
  • Dix-Hallpike manoeuvre
    • Used in suspected BPPV
    • Procedure:
      • Patient sits on the examination table
      • Rotate the head 45 degrees to the side of the suspected BPPV
      • Keeping the neck rotated, quickly lay the patient in a supine position so that their head hangs slightly off the short end of the table
      • Hold this position for 20 seconds
      • Slowly reposition patient into the original seated position
    • Negative:
      • Patient experiences no vertigo
      • No nystagmus appears
    • Positive:
      • Patient experiences vertigo and nystagmus when supine, which spontaneously resolve within the 20 seconds
  • (Halmágyi) head impulse test (HIT)
    • Determines whether the vestibuloocular reflex is intact
    • Procedure:
      • Patient sits or stands before you
      • Ask the patient to fix their gaze on your nose
      • Quickly turn the patient’s head to each side 15° multiple times and observe whether the patient loses the visual fixation
    • Negative:
      • Patient maintains visual fixation on your nose
    • Positive:
      • Patient’s eyes “turn away” when turned to the affected side, but is quickly corrected
      • Positive: Vestibular lesion on the affected side
  • Alternating cover test
    • Determines whether there is skew deviation, a sign of central vestibular lesions
    • Procedure:
      • Ask the patient to fix their gaze on your nose
      • Cover one of the patient’s eyes for a while
      • Suddenly move the cover to the other eye
      • Examine the recently uncovered eye for movements
    • Negative:
      • The uncovered eye does not do any corrective movements
    • Positive:
      • The uncovered eye performs a small corrective movement
  • Epley repositioning manoeuvre
    • Indicated if Dix-Hallpike is positive
    • This procedure moves the stone from the posterior semicircular canal into the utricle, improving symptoms
    • Procedure:
      • Patient sits on the examination table
      • Rotate the head 45 degrees to the side of the suspected BPPV
      • Keeping the neck rotated, quickly lay the patient in a supine position so that their head hangs slightly off the short end of the table
      • Hold this position for 30 seconds, or until the nystagmus disappears
      • Turn patient’s head by 90° towards the unaffected side
      • Hold this position for 30 seconds, or until the nystagmus disappears
      • Turn patient’s head another 90° towards the unaffected side, so that the patient is lying on their side with they head facing the ground
      • Hold this position for 30 seconds, or until the nystagmus disappears
      • Slowly bring patient back to a seated, upright position with the head in a neutral position
      • Ask patient to remain in this position for about 15 minutes