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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Diagnosis of BPPV begins with the health care practitioner taking a detailed history and performing a physical examination. History may include questions in regard to when the vertigo began, how long it lasted and whether certain positions make it better or worse. Information about past medical history, medications, and recent surgeries may be helpful. Other potential complaints need to be assessed including presence of fever or chills, weakness, recent falls, loss of power or sensation on one side of the body, loss of vision or hearing, ringing in the ears, headache, neck stiffness, or slurred speech.

Physical examination will focus on the neurologic exam. The health care practitioner will want to assure there is normal movement and sensation in the patient's body. Morevoer, it is important to make certain that the cause of the vertigo does not arise in the cerebellum, the part of the brain that is responsible for balance and coordination, so the health care practitioner may perform a few physical tests of the person's balance.

During the eye exam, the health care practitioner may try to demonstrate nystagmus (involuntary eye movements that occur as the brain tries to compensate for the abnormal signals it is receiving from the inner ear). Sometimes the health care practitioner will need to have the patient change positions to get nystagmus to occur; the position change often reproduces the vertigo complaint. This reproduction of symptoms is called the Dix-Hallpike test.

The diagnosis of benign paroxysmal positional vertigo frequently is made by history and physical examination so no further tests are needed. However, if there is concern that another less benign cause of vertigo may be present, other tests may be required.

• Blood tests may look for infection or electrolyte abnormalities.
  
  
• Imaging tests of the head and neck may include CT or MRI scans.
  
  
• Audiology tests may assess hearing.

Specialists that can help with the diagnosis and treatment include otolaryngologists (ear, nose, and throat physicians), neurologists and physical therapists specializing in vestibular rehabilitation.

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