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Dix-Hallpike maneuver

Indications: - used in the assessment of vertigo - most useful in evaluation of suspected benign-positional vertigo * side-lying test may be appropriate for patients unable to tolerate full neck extension Contraindications: - not useful for evaluation of Meniere's disease Procedure: - the sitting patient's head is placed in extension, then rotated 45 degrees to one side, then lowered to 30 degrees below the horizontal plane - the patient is observed for nystagmus (rotational or vertical) & symptoms of vertigo Interpretation: 1) benign positional vertigo* a) rotational nystagmus & vertigo occur, generally only on one side; vertigo severe prior to fatigue (see below) b) dizziness (vertigo) & nystagmus begin in 2-20 seconds [2] c) vertigo generally severe d) duration of nystagmus < 1 minute e) vertigo stops in < 30-60 seconds f) the response fatigues; nystagmus & vertigo decrease with repetition, that is, it is not observed after a few repetitions g) nystagmus unidirectional, mixed upbeat & torsional with small horizontal component 2) central vertigo generally a) vertigo generally mild b) dizziness (vertigo) & nystagmus begin immediately c) vertigo does not stop rapidly d) duration of nystagmus > 1 minute e) elicits vertical nystagmus or horizontal nystagmus without torsional component f) vertigo is not fatigable; vertigo does not decrease with repetition * see Epley maneuver for treatment of benign positional vertigo

Related

Epley procedure/maneuver (canalith repositioning) side-lying test vertigo

General

maneuver physical examination technique

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1013
  2. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 19 American College of Physicians, Philadelphia 2006, 2012, 2021.
  3. Parham K, Kuchel GA. A geriatric perspective on benign paroxysmal positional vertigo. J Am Geriatr Soc. 2016;64(2):378-385 PMID: 26804483
  4. Phillips J Vertigo - Dix-Hallpike Manoeuvre from BMJ Learning https://www.youtube.com/watch?v=8RYB2QlO1N4