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BPPV – Epley — SCE Neurology MCQ

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HardHeadache & Facial PainBPPV – EpleySCE Neurology

A patient has seconds-long vertigo when rolling to the right. Right Dix–Hallpike testing produces a brief latency followed by fatigable upbeat torsional nystagmus. There are no focal neurological signs or hearing symptoms. What is the best treatment?

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Correct answer: A — Perform a right-sided Epley canalith-repositioning manoeuvre

The best answer is “Perform a right-sided Epley canalith-repositioning manoeuvre”. The positional trigger and classic posterior-canal nystagmus identify posterior-canal BPPV; an Epley manoeuvre moves otoconia through the canal and is more specific than symptomatic drug treatment. “Prescribe prolonged vestibular suppressants without repositioning” is less appropriate because vestibular suppressants may impair compensation and do not correct canalithiasis “Treat as vestibular neuritis with corticosteroids” is less appropriate because neuritis causes sustained spontaneous vertigo and unidirectional nystagmus “Arrange thrombolysis for a posterior-circulation stroke” is less appropriate because the reproducible peripheral positional pattern lacks central stroke features “Start migraine prevention for a multi-hour vestibular syndrome” is less appropriate because vestibular migraine attacks usually last minutes to days and need migraine linkage

Reference: NICE NG127: Suspected neurological conditions — recommendations. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations