This topic contains 2 replies, has 2 voices, and was last updated by Bernard Tonks 1 year, 1 month ago.
April 12, 2018 at 10:11 am #73724
Why did you choose this article or document?
Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular dysfunction, affecting a predominantly older population. While the etiology is unclear, one of the proposed mechanisms of causation is vertebrobasilar insufficiency (VBI) and the subsequent ischemic changes involving the vestibular systems.
This study attempts to investigate the relationship between morphological changes in vertebrobasilar arterial structure and BPPV in older persons.
What is the question being asked?
The study asks whether there is a relationship between VBA changes and the presence of BPPV in individuals.
If it was an experimental design:
Who were the participants in the study? Who might we apply this research to in our clinical practice?
Participants were older individuals with a range of ages between 65 and 88, mean age was 73. In clinical practice, this would be the population that we would potentially apply the research conclusions too.
What were the hypotheses?
The hyposthesis was that VBA lesions lead to VBI and the subsequent compromised posterior circulation predisposes individuals to developing BPPV
Are there any outcomes or variables of interest?
A significant number of participants with BPPV demonstrated vertebral artery occlusion or stenosis (21.2%) compared to the control group.
A significant number of participants with BPPV demonstrated VBA abnormalities such as unilateral or bilateral VA tortuosity (24%) or VA dominance or hypoplasia (19.2%) compared to the control group
What did they conclude?
Abnormalities of the VBA system may be an important contributing factor in the development of BPPV in older persons. Compromised posterior circulation may be a risk factor for BPPV.
Can you comment on the validity of the study?
No. There were a number of limitations relating to this study: small number of subjects (104 people), the criteria for diagnosing BPPV (patterns of nystagmus) was no explicitly explained, the scale used for assessing the severity of vertigo was questionable.
How do the results relate to current practice or influence future practice?
This study is interesting, despite it’s limitations, because it has the potential to change the way we engage clinically with BPPV patients. What this study suggests is that there may be a more significant link between BPPV and VBI than is currently understood and that compromised posterior circulation may be an important contributing factor in BBPV for some patients.
The most common assessment test for BPPV, the Dix-Hallpike, and subsequent treatment intervention, the Epley maneuver, both involve neck extension coupled with rotation. During the Epley, these positions are typically held for 2-3 minutes.
Neck extension, coupled with rotation, is thought to be a position that can places mechanical stress on the contralateral VA.
If presence of BPPV may be an indicator of underlying VBI in some patients, then assessment and treatment interventions that stress the VA system may not be the best clinical choice for some patients.
August 10, 2018 at 7:54 pm #73774
- This topic was modified 1 year, 5 months ago by Meaghan Adams.
Bernard, would you refrain from doing the epley maneuver in patients with vbi? If so how would you treat their bppv?
Thanks!August 13, 2018 at 11:53 pm #73778
In the presence of VBI or suspected VBI the Epley maneuver is not an optimal choice to treat BPPV. If the BPPV presented as vertical canal canalithiasis (the most common variant) then the Gans Maneuver would be a good choice. It’s modification of the Epley that eliminates the need for any neck extension.
For horizontal canal BPPV then the Lempert or Barbecue Roll would be fine (for canalithiasis).
Hope this helps.