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1 Posterior Canal BPPV Pre- and Post-Epley Maneuver𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical right posterior canal benign paroxysmal positional vertigo (BPPV), which was provoked by the Dix-Hallpike maneuver. When the patient was moved into the right Dix-Hallpike maneuver, after a b...BPPV Posterior; BPPV Diagnosis; BPPV Treatment; Jerk Nystagmus; Vestibular Nystagmus
2 Dix-Hallpike Maneuver in Posterior BPPV with Reversal of Nystagmus on Sitting Up𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical posterior canal (PC) benign paroxysmal positional vertigo (BPPV), which is provoked by the Dix-Hallpike maneuver. When the patient is moved into the right Dix-Hallpike maneuver, after a brie...BPPV Posterior; BPPV Diagnosis; Jerk Nystagmus; Vestibular Nystagmus
3 Modified (Chair) Dix-HallpikeThe safety of the patient should be prioritized when completing this test virtually, and the examiner should avoid putting the patient in a position where a fall may occur. Modified (chair) Dix-Hallpike:(1) this test can be used for patients who may not be able to safely undertake the traditional Di...Modified (Chair) Dix-Hallpike
4 Dix-HallpikeThe safety of the patient should be prioritized when completing this test virtually, and the examiner should avoid putting the patient in a position where a fall may occur. Floor (or bed) Dix-Hallpike: this test can be used for patients who are fully mobile and able to get down to the floor and up a...Dix-Hallpike
5 Right Dix Hallpike Test (Video)The Dix-Hallpike tests for benign paroxysmal positional vertigo (BPPV). A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. When the head is in this position, it allows the posterior canal to be aligned with the gravitational vect...Benign Paroxysmal Positional Vertigo (BPPV); Vertigo; Nystagmus; Dizziness
6 Test Your Knowledge - Acute Prolonged VertigoThis is a 60-year old man with diabetes presenting with acute onset prolonged vertigo that was ongoing at the time of this examination. Which of the following statements are true with regard to the localization and/or etiology of this patient's symptoms? A. Whether or not symptoms worsen with head ...Abnormal Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Syndrome; Video Head Impulse Test
7 Right Dix Hallpike TestThe Dix-Hallpike tests for benign paroxysmal positional vertigo (BPPV). A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. When the head is in this position, it allows the posterior canal to be aligned with the gravitational vect...Benign Paroxysmal Positional Vertigo (BPPV); Vertigo; Nystagmus; Dizziness
8 Posterior Canal BPPV with Fixation and with Fixation RemovedThis is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsion...Benign Paroxysmal Positional Vertigo; BPPV; Dix-Hallpike; Posterior Canal; Vestibular Nystagmus; Jerk Nystagmus
9 Side-lying Test for Right BPPV (Video)The side-lying test is an alternative for the Dix Hallpike Test as it reduces the need for cervical extension. The interpretation of a positive test is the same as the Dix Hallpike Test.Benign Paroxysmal Positional Vertigo (BPPV); Dizzy; Vertigo; Positional Vertigo
10 Atypical PC BPPV Variant FiguresFigure 1: Atypical posterior canal BPPV variants The labyrinth consists of the cochlea (C), two otolithic organs including utricle (U) and saccule (S), and three semicircular canals including anterior canal (AC), horizontal canal (HC), and posterior canal (PC). A. If otoconia are located within the ...BPPV
11 Side-lying Test for Right BPPVThe side-lying test is an alternative for the Dix Hallpike Test as it reduces the need for cervical extension. The interpretation of a positive test is the same as the Dix Hallpike Test.Benign Paroxysmal Positional Vertigo (BPPV); Dizzy; Vertigo; Positional Vertigo
12 Anterior Canal BPPV𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Although the anterior canal (AC) variant of benign paroxysmal positional vertigo (BPPV) is rare, mainly owing to its orientation relative to gravity (which makes otoconial debris much less likely to enter it), it can occu...BPPV Anterior; BPPV Diagnosis; Jerk Nystagmus; Vestibular Nystagmus
13 Positional Nystagmus During an Attack of Vestibular Migraine𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A 50-year-old woman presented to clinic after experiencing multiple episodes of hours-long vertigo attacks that were associated with headache, photophobia and phonophobia. She had a history of motion sickness and migraine...Central Positional Nystagmus; Downbeat Nystagmus; Rotary Nystagmus; Jerk Nystagmus
14 Right Half Hallpike TestThe Half Hallpike Test compliments the Dix Hallpike Test and is traditionally used to assist with the diagnosis of posterior canal-benign paroxysmal positional vertigo (BC-BPPV), cupulolithiasis, as it may produce a greater degree of deflection under the action of gravity without latency when the ot...Benign Paroxysmal Positional Vertigo; Positional Vertigo; Dizziness; Nystagmus
15 Right Half Hallpike Test (Video)The Half Hallpike Test compliments the Dix Hallpike Test and is traditionally used to assist with the diagnosis of posterior canal-benign paroxysmal positional vertigo (BC-BPPV), cupulolithiasis, as it may produce a greater degree of deflection under the action of gravity without latency when the o...Benign Paroxysmal Positional Vertigo; Positional Vertigo; Dizziness; Nystagmus
16 The Virtual (Telemedicine) Vestibular Examination𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This document is based on Approach to the Ocular Motor & Vestibular History and Examination: https://collections.lib.utah.edu/ark:/87278/s64x9bq1, but adapted and edited for the telemedicine exam. Virtual vestibular ex...Saccades; Ocular Stability; Vestibular Examination
17 Idiopathic Downbeat Nystagmus Exacerbated with Positional Maneuvers𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 45-yo-woman with vertical oscillopsia for 6+ months, found to have downbeat nystagmus on examination. She mainly complained of dizziness and oscillopsia when laying down. She was found to have a significant exac...Downbeat Nystagmus; Jerk Nystagmus; Central Positional Nystagmus
18 The Most Common Audiovestibular Laboratory Tests, and the Specific Conditions in Which They May Assist in Making or Supporting the DiagnosisVN = vestibular neuritis; VM = vestibular migraine; VP = vestibular paroxysmia; vHIT = video head impulse test; VNG = video-nystagmography; ENG = electronystagmography; VOG = video-oculography; VEMPs = vestibular evoked myogenic potentials; SCDS = superior canal dehiscence syndrome; BPPV = benign pa...Vestibular Examination; Vestibular Lab Testing
19 Positional Downbeat Nystagmus Mimicking Anterior Canal BPPVAlthough positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke ...Cerebellar; Jerk Nystagmus; Downbeat Nystagmus; Central Positional Nystagmus
20 Central Positional Vertigo and Nystagmus in a Posterior Fossa Tumor𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year old woman who presented with positional vertigo and vomiting following a concussion related to a car accident 3 months prior. She was initially diagnosed with posterior canal (PC) benign paroxysmal posit...Vestibular Nystagmus; Jerk Nystagmus; Gaze-Evoked Nystagmus; Central Positional Nystagmus; Cerebellar OMS; Downbeat Nystagmus; Upbeat Nystagmus
21 The Virtual (Telemedicine) Ocular Motor Examination𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This document is based on Approach to the Ocular Motor & Vestibular History and Examination: https://collections.lib.utah.edu/ark:/87278/s64x9bq1, but adapted and edited for the telemedicine exam. Virtual Ocular Motor Ex...Saccades; Ocular Stability; Vestibular Examination
22 Posterior Canal BPPV Treated with Semont ManeuverThis is a patient with left posterior canal (PC) benign paroxysmal positional vertigo (BPPV), and upbeat-torsional (towards the left ear) nystagmus was provoked by left Dix-Hallpike maneuver and left side-lying maneuver. This video demonstrates treatment of her left PC BPPV with the Semont maneuver....BPPV Posterior; BPPV Diagnosis; BPPV Treatment; Jerk Nystagmus; Vestibular Nystagmus
23 Apogeotropic and Downbeat Central Positional Nystagmus Provoked While SeatedThis is a young man with intermittent complaints of positional vertigo. With Dix-Hallpike and roll testing, he had apogeotropic positional nystagmus (e.g., right beating nystagmus with the left ear down, and left beating nystagmus with the right ear down) in addition to strong downbeat nystagmus in...
24 ENG, VNG, & VOG𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Electronystagmography (ENG), and videonystagmography (VNG) or videooculography (VOG) are a collection of tests of eye movements that are performed either using surface electrodes around the eye (ENG) or with video goggles...Vestibular Lab Testing; ENG, VNG, & VOG
25 Centripetal Nystagmus ExampleA 68-year-old female reported a 2-year history of progressive gait imbalance, falls, dizziness and vertical oscillopsia. She described that dizziness and oscillopsia were worst when looking down. There was no family history of ataxia. Composite gaze with fixation was recorded with video-oculography ...Gaze-evoked Nystagmus; Rebound Nystagmus; Centripetal Nystagmus; Cerebellar Degeneration
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