Benign Paroxysmal Positional Vertigo (BPPV)

- Sudden sensation that the person having this condition is spinning or his
environment is spinning around him.
- Characterized by a brief episodes of intense dizziness
- Symptoms are triggered by specific changes in the position of your head,
such as tipping your head up or down, and by lying down, turning over or
sitting up in bed
- Can cause out of balance when waking up or standing
Causes
About half the time, doctors can't find a specific cause for BPPV.
When a cause can be determined, BPPV is often associated with a minor to
severe blow to your head. Less common causes of BPPV include disorders that
damage your inner ear or, rarely, damage that occurs during ear surgery or during
prolonged positioning on your back.
The ear's role
Inside your ear is a tiny organ called the vestibular labyrinth. It includes three
loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors
that monitor the rotation of your head. Other structures (otolith organs) in your ear
monitor movements of your head up and down, right and left, back and forth and
your head's position related to gravity. These otolith organs the utricle and saccule
contain crystals that make you sensitive to movement and gravity.
For a variety of reasons, these crystals can become dislodged. When they
become dislodged, they can move into one of the semicircular canals especially
while you're lying down. This causes the semicircular canal to become sensitive to head
position changes it would normally not respond to. As a result, you feel dizzy.
Pathophysiology

Modifiable Factors:
Activity / work
Exposure to loud music / sounds

Non-Modifiable Factors:
Age: elderly 65 years old above, but can happen at any age.
Prior head injury
History of disorders in the balance organs
Neck injury

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BPPV
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loss of sensitivity within the

Signs and Symptoms

- Weakness
- Nystagmus
- Vomiting
- Loss of balance
- Complaints of headache
- Blurred vision
- Diagnostics
- Dix Hallpike Testing
Performed with patient sitting upright with legs extended. The patients
head is then rotated 45 degrees in one side and then the patient is
checked for nystagmus. The examiner assists the patient in lying down
immediately, ensuring that the patients head is below the bed, and then
the examiner turns the head of the patient in one side and then the patient
is checked for nystagmus. The test is being repeated but this time to the
other side of the patient.
- Electronystagmography or videonystagmography
Visualization of the eye while performing the Dix Hallpike test to check for
presence of nystagmus.
- MRI
- Treatment
- Bedrest
- Antivertigo drugs (eg: betahistine HCl (Serc))
- Assistance in changing positions
- Check for BP
- Adequate fluid intake
- Lung Mass
- Solitary pulmonary nodules that are found at a rate of 1 to 2 per 1000 chest
radiographs
- 30% of these cases can be malignant
- 2 5 % can be considered as primary lung tumors
- Cause
- Unknown
- Pathophysiology
Modifiable
Factors:
Non-Modifiable Factors:
Smoking
Age: 40 years old and above
Alcoholism Family history of cancer
Exposure to toxic
fumes and DES
-

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Neoplastic growth on lung
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Signs and Symptoms

Dyspnea
Cyanosis
Easy fatigability
Pseudoasthmatic wheezing
Persistent coughing

Fever
Hemoptysis
Diminished breath sounds
Dullness to percussion
Rales

Diagnostics
Chest X-ray
Check for high levels of serotonin and 5-hydroxyindoleacetic acid (5-HIAA)
ABG
Pulmonary function test
CT Scan
PET Scan
ECG
Bronchoscopy
Guided Transthoracic Needle Aspiration Biopsy
Treatment
Lung wedge resection
Posteriolateral thoracostomy
Segmental Resection
Lobectomy
Sleeve Resection, or Pneumonectomy