Dix–Hallpike test: Difference between revisions
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The '''Dix–Hallpike test'''<ref name="pmid14941845">{{cite journal |vauthors=Dix MR, Hallpike CS |title=The pathology symptomatology and diagnosis of certain common disorders of the vestibular system |journal=Proc. R. Soc. Med. |volume=45 |issue=6 |pages=341–54 |year=1952 |pmid=14941845 |doi= |format=Scanned & PDF |pmc=1987487}}</ref> — or '''Nylen–Barany test''' — is a diagnostic maneuver used to identify [[benign paroxysmal positional vertigo]] (BPPV).<ref>{{WhoNamedIt|synd|3615|Dix-Hallpike manoeuvre}}</ref> |
The '''Dix–Hallpike test'''<ref name="pmid14941845">{{cite journal |vauthors=Dix MR, Hallpike CS |title=The pathology symptomatology and diagnosis of certain common disorders of the vestibular system |journal=Proc. R. Soc. Med. |volume=45 |issue=6 |pages=341–54 |year=1952 |pmid=14941845 |doi= |format=Scanned & PDF |pmc=1987487}}</ref> — or '''Nylen–Barany test''' — is a diagnostic maneuver used to identify [[benign paroxysmal positional vertigo]] (BPPV).<ref>{{WhoNamedIt|synd|3615|Dix-Hallpike manoeuvre}}</ref> |
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يتم تنفيذ اختبار ديكس-هول بايك مع المريض يجلس [يرية هو نحو الأذن المصابة، وهو الأذن أقرب إلى أرض الواقع. يعرف اتجاه مرحلة سريعة من قبل دوران رأس العين، إما في اتجاه عقارب الساعة أو عكس اتجاه عقارب الساعة. تتوفر للمساعدة في أداء مناورة ديكس-هول بايك للمرضى مع تشخيص BPPV الأجهزة المنزلية. [4] |
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هناك العديد من الخصائص الأساسية لاختبار إيجابي: |
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الكمون من بداية (عادة 5-10 ثوان) |
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الالتوائية (التناوب) رأرأة. إذا لم يحدث رأرأة التوائية ولكن هناك upbeating أو downbeating رأرأة، وأشارت إلى الجهاز العصبي المركزي (CNS) ضعف. |
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Upbeating أو downbeating رأرأة. Upbeating رأرأة يشير إلى أن الدوار موجود في القناة الهلالية الخلفية ل(أقل الأذن) الجانب اختبارها. Downbeating رأرأة يشير إلى أن الدوار هو في القناة الهلالية الأمامية لل(الأذن العليا) الجانب المقابل. |
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رأرأة Fatigable. سوف تكرار متعددة من الاختبار يؤدي في أقل وأقل رأرأة. |
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الانعكاس. على الجلوس بعد مناورة إيجابية اتجاه رأرأة أن تتراجع لفترة وجيزة من الزمن. |
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لإكمال الاختبار، يتم جلب المريض إلى وضع الجلوس، ويتم |
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==Negative test== |
==Negative test== |
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Revision as of 18:35, 19 September 2016
| Dix–Hallpike test | |
|---|---|
| ICD-9-CM | 95.46 |
The Dix–Hallpike test[1] — or Nylen–Barany test — is a diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV).[2]
Negative test
If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered.
Advantages
Although there are alternative methods to administering the test, Cohen proposes advantages to the classic maneuver. The test can be easily administered by a single examiner, which prevents the need for external aid. Due to the position of the subject and the examiner, nystagmus, if present, can be observed directly by the examiner.[3]
Limitations
The negative predictive value of this test is not 100%. Some patients with a history of BPPV will not have a positive test result. The estimated sensitivity is 79%, along with an estimated specificity of 75%.
The test may need to be performed more than once as it is not always easy to demonstrate observable nystagmus that is typical of BPPV. The test results can also be affected by the speed the maneuver is done in and the plane the occiput is in.[4]
There are several disadvantages proposed by Cohen for the classic maneuver. Patients may be too tense, for fear of producing vertigo symptoms, which can prevent the necessary brisk passive movements for the test. A subject must have adequate cervical spine range of motion to allow neck extension, as well as trunk and hip range of motion to lie supine. From the previous point, the use of this maneuver can be limited by musculoskeletal and obesity issues in a subject.[3]
Precautions and contraindications
In rare cases a patient may be unable or unwilling to participate in the Dix–Hallpike test due to physical limitations. In these circumstances the side-lying test or other alternative tests may be used.[5]
Precautions
- The Dix–Hallpike maneuver places a degree of stress on the patient’s lower back therefore a cautious approach must be taken with patients that are suffering from back pain.[6]
- Severe respiratory or cardiac problems may not allow a patient to tolerate the maneuver. For example a patient with orthopnoea may not be able to participate in the procedure as the patient may have troubling breathing when they lie down.[6]
Absolute contraindications
- Neck surgery[6]
- Severe rheumatoid arthritis[6]
- Atlantoaxial and occipitoatlantal instability[6]
- Aplasia of odontoid process[6]
- Cervical myelopathy[6]
- Cervical radiculopathy[6]
- Carotid sinus syncope[6]
- Vascular dissection syndromes[6]
See also
- Tilt table test
- Epley maneuver – used to treat BPPV
Footnotes
- ^ Dix MR, Hallpike CS (1952). "The pathology symptomatology and diagnosis of certain common disorders of the vestibular system" (Scanned & PDF). Proc. R. Soc. Med. 45 (6): 341–54. PMC 1987487. PMID 14941845.
- ^ Dix-Hallpike manoeuvre at Who Named It?
- ^ a b Cohen, H.S. (2004). "Side-Lying as an Alternative to the Dix-Hallpike Test of the Posterior Canal". Otology & Neurotology. 25: 130–134. doi:10.1097/00129492-200403000-00008. PMID 15021771.
- ^ Bhattari H (2010). "Benign Paroxysmal Positional Vertigo: Present Perspective". Nepalese Journal of ENT Head and Neck Surgery. 1 (2): 28–32.
- ^ Halker B, Barrs D, Wellik K, Wingerchuk D, Demaerschalk B (2008). "Establishing a Diagnosis of Benign Paroxysmal Positional Vertigo Through the Dix-Hallpike and Side-Lying Maneuvers: A Critically Appraised Topic". The Neurologist. 14 (3): 201–204. doi:10.1097/NRL.0b013e31816f2820.
- ^ a b c d e f g h i j Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology. 42 (3): 166–173. doi:10.3109/14992020309090426.