Diagnosing Benign Paroxysmal Positional Vertigo

BPPV, Benign Paroxysmal Positional Vertigo, can be easy to diagnose subjectively, but watching eyes can be difficult. The following is a chart illustrating the direction of eye movement, position of your patient’s head, and the corresponding diagnosis.

BPPV Diagnosis Nystagmus Position
Right Posterior Canal Canalithiasis  Right Upbeating Torsional Nystagmus Right Dix-Hallpike Position
Left Posterior Canal Canalithiasis Left Upbeating Torsional Nystagmus Left Dix-Hallpike Position
Right Horizontal Canal Canalithiasis More intense Right Geotropic Nystagmus Right Roll Test (compared to Left Roll Test Position)
Left Horizontal Canal Canalithiasis More intense Left Geotropic Nystagmus Left Roll Test (compared to Right Roll Test position)
Right Horizontal Canal Cupulolithiasis Less intense Right Ageotropic & more intense Left Ageotropic nystagmus Right or Left Roll Test position respectively
Left Horizontal Canal Cupulolithiasis Less intense Left Ageotropic & more intense Right Ageotropic nystagmus Left or Right Roll Test position Respectively 
Right Anterior Canal Canalithiasis Downbeating (and sometimes torsional) Nystagmus Left Dix-Hallpike Position
Left Anterior Canal Canalithiasis Downbeating (and sometimes torsional) Nystagmus Right Dix-Hallpike Position

 

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