providers

Vertebral Basilar Insufficiencies (VBI) vs. non-classic BPPV

Published on: February 13, 2013

Current Neurology literature continues to present cases of vertebral basilar insufficiencies (VBI), vertebral artery ischemia (VA stroke) and cervical artery dissections (Choi JH et al, 2011, Kim BM et al 2011, Schievink WI and Debette S, 2011, Volker W et al, 2011).

This should be of particular interest to clinicians examining patients with complaints of positional vertigo; to be sure they are not confused with a “non-classical” BPPV.  Many of these patients will have symptoms with hyperextension of the neck with rotation or lateral tilt. Since the condition will be provoked in a static head-neck position, unlike a PC-BPPV, the nystagmus may be of any type (horizontal, vertical or torsional), but most importantly it will not fatigue. Likewise, the patient may report other focal neurological symptoms typically unrelated to a BPPV response. Although there is some controversy as to whether vertebral artery screening is reliable based on concerns of its sensitivity, it is apparent that VBI is a relatively common problem even in young adults. The elderly who have a higher prevalence of BPPV also have co-morbidities of osteoarthritis and cervical spondylosis.

AIB protocol includes:

  1. Vertebral artery screening (VAS) – seated prior to modified Hallpike. Despite the acknowledgement of reduced sensitivity it may provide guidance for selection of testing protocols.
  2. Modified Hallpike procedures. Fully supported techniques only (no head hanging off table).  If the VAS was positive-seated, then only side-lying modified Hallpike will be used.
  3. If there is no fatiguing of response (i.e. nystagmus, vertigo, nausea), these are likely neuro-vascular symptoms not BPPV.
  4. A “non” classic BPPV may be seen on occasion without nystagmus, but with a transient vertigo with latency and duration of no more than 10-12 seconds. As reported by Haynes et al. 2002, this may be successfully treated by repositioning and re-checked. If it was a BPPV, transient vertigo should be gone.
  5. If a VBI is considered, consultation with referring physician and neurology is strongly indicated.
  6. For those patients with both a VBI and PC-BPPV, Semont or Gans repositioning maneuvers for BPPV treatment are indicated as neither requires hyperextension.

Recent Posts

Comparison between Epley and Gans Repositioning Maneuvers for Posterior Canal BPPV: A Randomized Controlled Trial

Published on: March 26, 2024

Annals of Indian Academy of Neurology | Volume 26 – Issue 4 – July-August 2023 Benign paroxysmal positional vertigo (BPPV) is one of the commonly occurring causes of vertigo. BPPV […]

Read more

How to evaluate and treat the dizzy patient: non-medical diagnosis-based strategies

Published on: February 16, 2024

ENT & Audiology News | Balance & Vestibular Disorders 2024 It is estimated that dizziness, vertigo and falls are the third most common complaints heard by physicians from all age […]

Read more

The cost of untreated vestibular conditions: the role of otolaryngology & rehabilitation

Published on: February 15, 2024

Journal of Otolaryngology-ENT Research | Volume 16 Issue 1 – 2024 It is estimated that dizziness, vertigo, and falls are the third most common complaints heard by physicians from all […]

Read more

Understanding Mal de Debarquement syndrome (MdDS), persistent postural perceptual dizziness (3PD) and somatoform disorders: and the role of vestibular rehabilitation therapy (VRT)

Published on: January 3, 2024

Volume 16 Issue 1 – 2024 Richard E Gans, Kimberly Rutherford, Allisson D’Alessandro American Institute of Balance, USA Correspondence: Richard E Gans, Founder and Executive Director of the American Institute […]

Read more