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Benign paroxysmal positional vertigo — SCE Geriatric Medicine MCQ

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ModerateFallsBenign paroxysmal positional vertigoSCE Geriatric Medicine

A 76-year-old woman is referred for recurrent brief spinning vertigo when turning over in bed. She has had two falls because she avoids moving her head; gait is otherwise steady with a stick. Dix-Hallpike testing to the right triggers torsional upbeat nystagmus lasting 20 seconds; neurological examination and hearing are normal. What is the most appropriate management?

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Correct answer: B — Perform an Epley manoeuvre and give safety-net advice

The positional vertigo with fatigable torsional upbeat nystagmus on Dix-Hallpike is posterior canal BPPV. Epley manoeuvre is an effective treatment and is specifically relevant to geriatric falls practice. Vestibular suppressants can increase falls and should not be used long term for BPPV. Red flags such as persistent neurological signs, new deafness or non-fatigable nystagmus would change the pathway.

Reference: BGS falls guidance; NICE CKS Vertigo; JRCPTB geriatric curriculum