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Vertigo - Dix-Hallpike Manoeuvre from BMJ Learning

Take the full BMJ Learning module on vertigo: https://bit.ly/dixhalpike This manoeuvre is used as a diagnostic test, used particularly when you suspect benign paroxysmal positional vertigo You should explain the procedure to the patient, and warn them that they may experience vertigo symptoms during it, but that the symptoms usually subside quickly. You should ask them to keep their eyes open throughout and stare at your face. Check that the patient does not have any neck injuries or other contraindications to rapid spinal movements Ask the patient to sit on an examination couch with their legs extended, close enough to the edge so that their head will hang over when they are laid flat Stand on their left side, take hold of their head with both your hands, and turn their head 45° towards you. (This tests the left posterior canal). Observe their eyes for 30 seconds. (Signs and symptoms usually occur when you turn the patient's head towards the lesion - if you suspect disease of the right ear, you may wish to start on their right side.) The authors recommend starting with the non-affected side Keeping the patient's head in the same position, lie them down quickly until their head is hanging over the edge of the couch (still turned 45° towards you) Observe their eyes for 30 seconds Lift the patient back up to sitting position, and repeat the test on their right side In a patient with BPPV, you will typically see a characteristic pattern of nystagmus emerge after 5-20 seconds, when the patient's head is hanging towards the side of the lesion. This is called torsional or rotatory nystagmus and has two components: a quick movement towards the side of the lesion and a slow component away from it. An upward beating nystagmus is often superimposed on this movement.