Spring 08 Week 5

An elderly woman came in who was previously diagnosed with BPPV and was given Meclizine to help with her symptoms upon diagnosis. She has had recurring symptoms in the last two weeks. She reported symptoms of lightheadedness especially when she first wakes up and has fallen previously. The duration of symptoms vary. She also has tingling and a sharp pain on the left side of her face particularly her eye. However, these symptoms do not always occur with the dizziness. The client noted having glaucoma and high blood pressure. She is currently taking Celebrex, a diuretic, and blood pressure medicine. She reported no problems with hearing during her vestibular symptoms or any other time. The client was instructed to not take any medication before having her vestibular evaluation.

An article that was found gives typical responses and symptoms of BPPV. It included 59 patients, 19 men and 40 women, with benign paroxysmal positional vertigo (BPPV). The patients filled in a questionnaire concerning their symptoms, earlier diseases, accidents and tobacco and alcohol use. None of the patients had hearing loss. The mean duration of the vertigo attacks ranged from a few seconds to 5 min, and they were fairly mild. The attacks were perceived as more intense if vertigo was rotational or if it was accompanied by nausea. The vertigo attacks occurred in spells; patients had several attacks a week (23%) or during the course of 1 day (52%). The vertigo was rotational in 80% of patients, and 47% experienced a floating sensation.


Kentala, E. & Pyykko, I. (2000). Vertigo in Patients with Benign Paroxysmal Positional Vertigo. Acta Otolaryngology, 543, 20-22.

http://web.ebscohost.com.www.libproxy.wvu.edu/ehost/pdf?vid=4&hid=15&sid=9a94e1ac-652f-424e-9d24-5f8185d7d5bf%40sessionmgr8

The Dix-Hallpike maneuver was performed to evaluate the presence or absence of nystagmus. Upon testing very strong rotary nystagmus was seen on the right side. Additionally, she reported feeling dizzy. These symptoms were positive for BPPV. No nystagmus was seen on the left side. Two rotations of the Epley maneuver were performed to the right side in order to successfully treat her BPPV. The client's results revealed positive signs of BPPV and the Epley was performed to reduce and treat the symptoms of BPPV. Reduction of symptoms and absent rotational nystagmus was observed during the second Dix-Hallpike maneuver. It was recommended that the client rest for a few days since the testing can cause some unsteadiness.