Differentiating different types of nystagmus can be clinically challenging.

The nystagmus typically wanes with repeated Dix-Hallpike tests.

Nystagmus typically lasts between 20-40 seconds.

Horizontal nystagmus suggests the involvement of the lateral semicircular canal. Rotary nystagmus is the most common type and suggests the involvement of the posterior semicircular canal.

A 2-20 second latent period followed by the onset of torsional (rotary) or horizontal nystagmus.

You should note the following characteristics of the nystagmus: If the test is positive, the patient will complain of vertigo and you should be able to observe nystagmus directly.īe aware that patients often feel very dizzy and nauseated when vertigo is triggered.Īsking the patient to fix their gaze once you’ve established nystagmus will often reduce their symptoms.

If the test is positive, the characteristics of the patient’s nystagmus should be observed (see details below) and you should then consider performing the Epley manoeuvre. If no nystagmus is observed on assessment of the other side, the patient should be sat up and an alternative diagnosis to BPPV should be considered.ĩ. In the case of a negative Dix-Hallpike test on the first side, after a short break, the test should be repeated on the other side, turning the patient’s head in the opposite direction during step 4. left or right), the test is then complete for that side and you should carefully help the patient sit back up.Ĩ. If no nystagmus is observed on the assessment of the first side (i.e. Inspect the patient’s eyes carefully for evidence of nystagmus for at least 30 seconds.ħ. Ask the patient to keep their eyes open throughout this process.Ħ. left or right) – if the patient has suggested turning their head to a particular side appears to trigger the symptoms, you should try this side first.ĥ. Whilst supporting the neck, move the patient from their sitting position to a supine position in one brisk smooth motion, ensuring their head hangs over the bed 30º below the horizontal plane. When performing the Dix-Hallpike test, make sure to warn the patient in advance of each step, so that they know what to expect:ġ. Ask the patient to sit upright on the examination couch.Ģ. Adjust the patient’s position so that when supine, their head will hang over the edge of the bed, allowing for head extension below the horizontal plane.ģ. Position yourself standing behind the patient.Ĥ. Turn the patient’s head 45º to one side (i.e. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of clinical examination stations ✨ Dix-Hallpike test Gain consent to proceed with the examination.Īsk the patient to sit on the examination couch. “Do you have any pain anywhere currently?”Ĭheck the patient has someone who can help them get home safely, as they may be dizzy after the procedure.“Do you have any neck or back problems?”.

The second stage will involve me holding your head whilst asking you to roll onto your side and then to sit upright.”Ĭheck if the patient has any back or neck problems that would contraindicate performing the assessments: The first stage will involve moving you from a sitting to a lying position briskly on the examination couch. Introduce yourself to the patient including your name and role.Ĭonfirm the patient’s name and date of birth.Īsk if the patient has noticed whether turning to one particular side seems to trigger the symptoms, which may provide an indication of the affected side.īriefly explain what the examination will involve using patient-friendly language: “Today I need to perform some assessments to help diagnose and possibly treat the dizzy episodes you’ve been experiencing. Wash your hands and don PPE if appropriate. Light-headedness or a sensation of nausea might last longer than one minute, however, if the sensation of movement persists for more than one minute alternative diagnoses should be considered. These patients experience vertigo in brief episodes lasting less than one minute with changes of head position and return to normal between episodes. The Dix-Hallpike manoeuvre is indicated for patients with paroxysmal vertigo in whom BPPV is considered in the differential diagnosis.

Vertigo epley maneuver pdf