Clinical diagnostic criteria for benign paroxysmal positional vertigo
Definition: It is a transient episode of vertigo induced by head movements or body posture changes, and is one of the most common peripheral vestibular disorders, belonging to the inner ear. The medical history may be self-limiting.
Classification: 50-70% of the cases are primary, also called idiopathic, with no obvious cause;
30-50% are secondary, often secondary to or complicated by pathological conditions such as vaginitis, vestibular neuritis, head trauma, migraine, episodes of Ménière’s disease, sudden deafness, and ear and ear neurosurgery.
Diagnostic criteria.
1., Transient episodes of vertigo induced by head movements or changes in body posture associated with the direction of gravitational action (the involved semicircular canal is aligned with the gravitational force). The vertigo is rotational or floating, and may be accompanied by mild headache, fear, nausea and unsteadiness.
2. The Dix-Hallpike test elicits characteristic nystagmus with vertigo, which is characterized by.
① Short latency (usually 1~5 seconds);
②Limited duration (usually <30 seconds);
(3) Rotational nystagmus induced when the affected ear is downward (posterior semicircular BPPV in the fast phase upward, anterior semicircular BPPV in the fast phase downward);
④ Reverse nystagmus was induced when the sitting position was restored;
⑤ Repeatedly placed in the evoked position, the response is weakened (nystagmus is fatiguing);
3. Differentiate or exclude vertebrobasilar artery insufficiency (VBI), cervical spondylosis, posterior cranial fossa tumors, and other disorders of the central nervous system.
Horizontal semicircular canal BPPV (variant): The affected ear induces a groundward or dorsal horizontal nystagmus with greater intensity than the non-lesioned ear.
Subjective (Subjective) BPPV: With the above mentioned history, The Dix-Hallpike test induces no significant nystagmus but is accompanied by vertigo symptoms, and canal stone repositioning treatment is effective.
Efficacy assessment.
Observation was started from 2 weeks after treatment and the efficacy was graded by comparing the disease status before and after 3 months of treatment as follows.
Grade 1: complete disappearance of vertigo and nystagmus;
Grade 2: BPPV is relieved, but other vertigo is still present;
Grade 3: partial relief of vertigo and nystagmus, significant improvement of positional vertigo (including reduction in the number of episodes and intensity of vertigo and nystagmus), but still present;
Grade 4: No change or worsening.