Dix-Hallpike Maneuver

Excerpt

Vertigo is a symptom characterized by a perceived sensation of motion, either of the self or the surroundings, in the absence of true motion. While it is a common complaint, evaluating a patient with vertigo can be challenging. The differential diagnosis for vertigo is broad, encompassing central and peripheral vestibular causes, cardiovascular disease, metabolic dysfunction, and medication reactions.

Most cases are mild and self-limited; however, studies have shown that up to 15% of patients with vertigo presenting in the emergency department may have life-threatening underlying causes. Therefore, clinicians must perform a thorough history and physical examination to distinguish between benign and serious causes, ensuring prompt evaluation and treatment for those requiring urgent attention.

Benign positional paroxysmal vertigo (BPPV) is the most common vestibular disorder globally, affecting approximately 2.4% of the general adult population over their lifetime. Typically, patients with BPPV experience spontaneous remission within days to weeks of symptom onset. Although BPPV is self-limited and can be treated with simple procedures, recurrence rates are high, with rates ranging from 36% to 50% reported in the literature. These frequent recurrences can have a significant negative impact on an individual's quality of life.

The Dix-Hallpike maneuver is a valuable tool clinicians utilize to differentiate one of the most prevalent and harmless causes of vertigo from potentially severe alternative diagnoses. It serves as the gold standard test for diagnosing BPPV. When properly employed, the Dix-Hallpike maneuver can confirm the diagnosis of posterior canal BPPV, enabling them to administer bedside maneuvers that often offer immediate relief to patients.