Oct 27, The Dix-Hallpike maneuver is a powerful tool in the physician patients can be given instructions on how to do this at home for recurrences. If the Dix-Hallpike test is abnormal and the findings are “classic” for BPPV, then additional testing is not necessary. If the results are normal or not “classic” then. Introduction. The Hallpike test (also known as the DixHallpike test or manoeuvre) was developed and introduced into clinical practice in (Dix and. Hal/pike.

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Dix–Hallpike test – Wikipedia

Epub Apr Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo. Personnel This test can be accomplished by a single practitioner.

Please review our privacy policy. Turn recording back on. The maneuver, when properly employed, can identify a common, benign cause of vertigo, which can then be treated with bedside maneuvers, often providing instant relief to patients.

Trick of the Trade: Dix-Hallpike maneuver

Any neurological deficit, especially truncal ataxia, should generate concern for a central cause and trigger further workup. Patients may be too tense, for fear of producing vertigo symptoms, which can prevent the necessary brisk passive movements for the test.

Author Information Authors Jonathan D. In rare cases a patient may be unable or unwilling to participate in the Dix—Hallpike test due to physical limitations. Retrieved from ” https: Video ENG equipment can be used by advanced practitioners to better monitor eye movements during this maneuver. Vertigo and dizziness in the emergency department. Talmud ; Scott C.

Dix–Hallpike test

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The test may need to be performed more than once as it is not always easy to demonstrate observable nystagmus that is typical of BPPV.


During normal rotational movement of the head, the fluid endolymph remains relatively motionless while the canals and the hair cells move. The jallpike then watches the patient’s eyes for torsional and up-beating nystagmus, which should start after a brief delay and instructlons for no more than one minute.

When performing the Dix—Hallpike test, patients are lowered quickly to a janeuver position lying horizontally with the face and torso facing up with the neck extended 30 degrees below vertical by the clinician performing the maneuver. Both the Dix—Hallpike and the side-lying testing position have yielded similar results.

StatPearls Publishing; Jan. Dizziness is a common complaint, and serious causes must kaneuver considered and excluded first. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Typically, after a five to second delay, this will cause vertigo and rotary or up-beating nystagmus, which will resolve within 60 seconds.

The Dix-Hallpike maneuver should be avoided in a patient with neck pathology, in whom the movements involved could be dangerous to the patient. While there is a high rate of recurrence and this is not always effective, relieving the symptoms of our instrutions in this way is highly desirable, and patients can be given instructions on how to do this at home for recurrences.

Contraindications The Dix-Hallpike maneuver should be avoided in a patient with neck pathology, in whom the movements involved could be dangerous to the patient.

Dix Hallpike Maneuver Jonathan D. The head is rotated 45 degrees away from the side being tested, and the eyes are examined for nystagmus.

Hallpikke All that is required for this test is a bed that can recline to horizontal, but certain equipment can be helpful, if available.

In these circumstances the side-lying test or other alternative tests may be used.

Zhonghua Nei Ke Za Zhi. If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered. This results in the sensation of movement and nystagmus characteristic of vertigo in brief paroxysms with positional changes of the head. Review Maneuvers for the treatment of benign positional paroxysmal vertigo: Cervical instability, vascular problems like vertebrobasilar insufficiency and carotid sinus syncope, acute neck trauma and cervical disc prolapse are absolute contraindications.


In patients without an absolute contraindication, one paper suggests briefly assessing neck rotation and extension before attempting the maneuver to see if these positions can be comfortably maintained for thirty seconds. If the test is negative but clinical suspicion remains high, the patient should be given a chance to recover for at least one minute, and then testing of the instryctions ear can be undertaken.

Frenzel goggles can be useful to magnify the movements of the eyes. Such patients include those who are too anxious about eliciting the uncomfortable symptoms of vertigo, and those who may not have the range of motion necessary to comfortably be in a supine position. Consider an antiemetic before implementing the test. The patient begins sitting up, and their head is oriented 45 degrees toward the ear to be tested.

To access free multiple maneuve questions on this topic, click here. Rate and predictors of serious neurologic causes of dizziness in the emergency department.

Trick of the Trade: Dix-Hallpike maneuver

This disease process is thought to be caused by free-floating debris often in the form of a calcium carbonate stones, termed otoliths in the semicircular canals of the inner ear. Similar articles in PubMed. The clinician then lies the patient down quickly with their head past the end of the bed and extends their neck 20 degrees below the horizontal, maintaining the initial rotation of the head.

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