HALLPIKE MANOEUVRE

                                         
                        Video to show how Hallpike Manoeuvre is done.

Method

·       Patient sits on a couch

·       Examiner holds the patient’s head, turns it to 45^o to the right and then places the patient in a supine position so that his head hangs 30^o below the horizontal

·       Patient’s eyes are observed for nystagmus

·       The test is repeated with head turned towards left and then in straight head hanging position

  

·       Four parameters of nystagmus are observed – latency, duration, direction, fatiguability

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In BPPV            

      · Nystagmus appears after a latent period of 2- 20 seconds, lasts for 1 minute and is always in                                                    one direction

       · On repetition of the test, nystagmus may still be elicited but lasts for a shorter period

 ·   On subsequent repetitions, it disappears together, i.e. nystagmus is fatiguable                                                         

      ·   Patient also complains of vertigo when the head is in critical position

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In central lesions (tumors of IVth ventricle, cerebellum, temporal lobe, multiple sclerosis, vertebrobasilar insufficiency or raised intracranial lesion), nystagmus is produced immediately as soon as the head is in critical position without any latency and lasts as long as head is in that critical position