Posterior canal BPPV is the commonest cause of brief positional vertigo, and both diagnosis and treatment can be done in clinic.
A positive Dix-Hallpike shows torsional, upbeating nystagmus with a short latency that fades within a minute. The Epley manoeuvre on the affected side resolves most cases in one or two sessions. Atypical nystagmus, persistent nystagmus or neurological signs should prompt assessment for a central cause.
- Look for short-latency, torsional upbeating nystagmus on Dix-Hallpike.
- Treat posterior canal BPPV with the Epley manoeuvre on the affected side.
- Avoid vestibular sedatives for BPPV.
- Refer atypical nystagmus or neurological signs urgently.
Why it matters
Most BPPV can be treated at the first visit without referral or medication.
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