Diagnosis of benign paroxysmal positional vertigo in Emergency Department: Our experience
The Benign Paroxysmal Positional Vertigo (BPPV) represents the first cause of peripheral vertigo in populations and it is determined by a displacement of otoconial fragments within the semicircular canals. Following the patient’s head movements, these fragments, moving by inertia, incorrectly stimulate the canals generating vertigo. The BPPV is diagnosable by observing the nystagmus that is generated in the patient following the Dix-Hallpike maneuver used for BPPV diagnosis of vertical semi-circular canal, and, following the supine head yaw test used for lateral semi-circular canal. Correctly identifying the origin of this specific peripheral vertigo, would mean to obtain a faster diagnosis and an immediate resolution of the problem for the patient. In this context, this study aims to identify precise training activities, aimed at the application of specific diagnostic maneuverers for algorithm decisions in support of medical personnel. The evaluations reported in this study refer to the data collected in the Emergency Department of the Cardarelli Hospital of Naples. The results obtained, over a six-month observation period, highlighted the advantages of the proposed procedures in terms of costs, time and number of BPPV diagnoses.
1. Lai YT, Wang TC, Chuang LJ, Chen MH, Wang PC. Epidemiology of vertigo: a National Survey. Otolaryngol Head Neck Surg. 2011;145(1):110-6.
2. Yin M, Ishikawa K, Wong WH, Shibata Y. A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx. 2009;36(1):30-5.
3. Kerber KA, Meurer WJ, West BT, Fendrick AM. Dizziness presentations in U.S. emergency departments, 1995-2004. Acad Emerg Med. 2008;15(8):744-50.
4. Post RE, Dickerson LM. Dizziness: a diagnostic approach. Am Fam Physician. 2010;82(4):361-8, 9.
5. Armato E, Ferri E, Pinzani A, Ulmer E. Cerebellar haemorrhage mimicking acute peripheral vestibulopathy: the role of the video head impulse test in differential diagnosis. Acta Otorhinolaryngol Ital. 2014;34(4):288-91.
6. Casani AP, Dallan I, Cerchiai N, Lenzi R, Cosottini M, Sellari-Franceschini S. Cerebellar infarctions mimicking acute peripheral vertigo: how to avoid misdiagnosis? Otolaryngol Head Neck Surg. 2013;148(3):475-81.
7. Grad A, Baloh RW. Vertigo of vascular origin. Clinical and electronystagmographic features in 84 cases. Arch Neurol. 1989;46(3):281-4.
8. Huon LK, Wang TC, Fang TY, Chuang LJ, Wang PC. Vertigo and stroke: a national database survey. Otol Neurotol. 2012;33(7):1131-5.
9. Lee CC, Su YC, Ho HC, Hung SK, Lee MS, Chou P, et al. Risk of stroke in patients hospitalized for isolated vertigo: a four-year follow-up study. Stroke. 2011;42(1):48-52.
10. Newman-Toker DE, Hsieh YH, Camargo CA, Jr., Pelletier AJ, Butchy GT, Edlow JA. Spectrum of dizziness visits to US emergency departments: cross-sectional analysis from a nationally representative sample. Mayo Clin Proc. 2008;83(7):765-75.
11. Ozono Y, Kitahara T, Fukushima M, Michiba T, Imai R, Tomiyama Y, et al. Differential diagnosis of vertigo and dizziness in the emergency department. Acta Otolaryngol. 2014;134(2):140-5.
12. Jung I, Kim JS. Approach to dizziness in the emergency department. Clin Exp Emerg Med. 2015;2(2):75-88.
13. Cappello M, di Blasi U, di Piazza L, Ducato G, Ferrara A, Franco S, et al. Dizziness and vertigo in a department of emergency medicine. Eur J Emerg Med. 1995;2(4):201-11.
14. Vanni S, Pecci R, Edlow JA, Nazerian P, Santimone R, Pepe G, et al. Differential Diagnosis of Vertigo in the Emergency Department: A Prospective Validation Study of the STANDING Algorithm. Front Neurol. 2017;8:590.
15. Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. Laryngoscope. 2013;123(9):2250-3.
16. Ammar H, Govindu R, Fouda R, Zohdy W, Supsupin E. Dizziness in a community hospital: central neurological causes, clinical predictors, and diagnostic yield and cost of neuroimaging studies. J Community Hosp Intern Med Perspect. 2017;7(2):73-8.
17. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5.
18. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139(5 Suppl 4):S47-81.
19. Xiang-Dong G. Benign paroxysmal positional vertigo. J Neurosci Rural Pract. 2011;2(1):109-10.
20. Kerber KA, Burke JF, Skolarus LE, Meurer WJ, Callaghan BC, Brown DL, et al. Use of BPPV processes in emergency department dizziness presentations: a population-based study. Otolaryngol Head Neck Surg. 2013;148(3):425-30.
21. Kerber KA, Forman J, Damschroder L, Telian SA, Fagerlin A, Johnson P, et al. Barriers and facilitators to ED physician use of the test and treatment for BPPV. Neurol Clin Pract. 2017;7(3):214-24.
22. Lloyd M, Mackintosh A, Grant C, McManus F, Kelly AM, Karunajeewa H, et al. Evidence-based management of patients with vertigo, dizziness, and imbalance at an Australian metropolitan health service: an observational study of clinical practice. Physiother Theory Pract. 2018:1-8.
23. Newman-Toker DE, Cannon LM, Stofferahn ME, Rothman RE, Hsieh YH, Zee DS. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc. 2007;82(11):1329-40.
24. Karatas M. Central vertigo and dizziness: epidemiology, differential diagnosis, and common causes. Neurologist. 2008;14(6):355-64.
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