SAQ 148 – Neurology – vertigo and repositioning therapy
Model Answer
Question 9. vertigo and repositioning therapy.
a. Peripheral versus central vertigo
| Clinical feature | Peripheral | Central |
|---|---|---|
| Hearing loss symptom | Often present. | Rare. |
| Other ear symptoms | Pain, tinnitus, or discharge. | Rare. |
| Other neurological symptoms | Rare. | Common, for example diplopia, paraesthesia, limb weakness, dysarthria, or dysphagia. |
| Nystagmus | Unidirectional / horizontal, constant direction, delayed onset from stimulus, fatigable. | Usually absent or bidirectional / rotatory, no latency from stimulus onset, does not fatigue. |
| Hallpike | Unidirectional, fatigable nystagmus. | Instantaneous, multidirectional, non-fatiguing nystagmus. |
| Hearing loss sign | Often. | Rare. |
| Other neurological signs | Absent except VIII. | Usually present. |
| Course | Self-resolving. | Persistent or relapsing. |
b. Repositioning therapy
- Sit upright with head central.
- Rapidly move head down 30 degrees below flat, facing the affected side noted on Hallpike.
- Hold for about 1 minute until symptoms resolve.
- Rotate head to the other side in the same 30 degree down position.
- Hold for about 1 minute until symptoms resolve.
- Continue rotation so the patient faces the floor.
- Hold for about 1 minute until symptoms resolve.
- Sit upright with head central for more than 20 minutes.
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