Essay Example on Vestibular Rehabilitation in Diagnosis and Management of Horizontal Canal

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Vestibular Rehabilitation in Diagnosis and Management of Horizontal Canal Benign Paroxysmal Positional Vertigo in an Inpatient Setting A Single Case Study Santosh Krishnamoorthy Abstract Background and Purpose Vertigo a sensation of whirling or deceptive impression of spinning environment is a widespread problem in elderly patients Vertigo can be devastating and impede the person from being independent In this case report the effects of Lempert maneuver is described in a patient with horizontal canal BPPV Keywords Vestibular Rehabilitation Benign Paroxysmal positional vertigo case report horizontal canal Case Description The patient was a 84 year old Caucasian female who was waiting at the doctor's office with complaints of leg pain while she was waiting for the doctor she presented with sudden onset of vertigo Patient was sent to acute care hospital and diagnosed with acute ischemic stroke Patient presented to therapy with severe vertigo and was convinced by the neurologist that the vertigo was a resultant of the stroke However vestibular evaluation revealed geotropic horizontal nystagmus in bilateral supine positions with supine roll test stronger on the right side when the right side was lowermost indicating positive right horizontal canal canalolithiasis which was treated with Lempert maneuver Outcomes The patient's vertigo was resolved by 100 and restored independent transfers and ambulation Supine roll test was performed upon each follow up for two weeks however the patient did not present with vertigo Discussion This case report demonstrates successful treatment for horizontal canal BPPV by Lempert maneuver in inpatient setting


The patient was diagnosed with acute infarcts to right posterior inferior cerebellar artery however the main reason for vertigo was from underlying horizontal canal BPPV The Lempert maneuver was performed twice after which the patient did not complain of any vertigo The patient was able to perform all activities of daily living without balance deficits After a two week stay in short term rehabilitation patient was able to return home Background Introduction Horizontal Canal Benign Paroxysmal Positional Vertigo Vertigo is an illusion of rotational motion 1 It is a widespread reason for balance deficits among the elderly population 2 Benign paroxysmal positional vertigo is the most commonest cause of vertigo in general population with a prevalence rate of 2 4 3 Recently there has been more horizontal canal BPPV cases reported 4 The diagnostic discovery of horizontal canal BPPV ranges from 10 to 42 7 5 6 This case report describes diagnosis and intervention for a patient with horizontal canal BPPV in a inpatient setting Benign Paroxysmal Positional Vertigo BPPV is common peripheral vestibular cause for vertigo 7 Horizontal canal BPPV is the second most common type 8 In horizontal canal BPPV turning the head on either side provokes vertigo which can persist for several minutes 8



The symptoms of vertigo are more severe in horizontal canal BPPV 8 Horizontal canal BPPV is further divided into two types according to the mechanism as canalolithiasis and cupulothiasis 8 Depending on position of the particles in the horizontal canal canalithiasis it can be further divided into long arm canalolithiasis and short arm canalolithiasis In long arm horizontal canal canalolithiasis the patient presents with geotropic nystagmus 9 The nystagmus is lateral and down beating stronger on the involved side when the involved ear is lowermost in supine roll test 9 In short arm horizontal canal canalithiasis the patient presents with apogeotropic nystagmus 9 The nystagmus is lateral and up beating when the involved ear is lowermost and no nystagmus in contralateral lateral position 9 In horizontal canal cupulolithiasis the patient presents with apogeotropic nystagmus 9 The patient presents with lateral upbeating nystagmus in bilateral supine positions stronger on the uninvolved side when the involved ear is uppermost 9 Case Description The patient was an 84 year old Caucasian female who suffered an acute ischemic stroke with acute infarcts to right posterior inferior cerebral artery territory resulting in ataxic gait 



The patient's medical history consisted of hypertension diabetes mellitus and atrial fibrillation During the patient's stay at the hospital she received skilled physical therapy however she was not able to actively participate in restorative physical therapy secondary to vertigo After a brief one week stay in the acute care hospital the patient was deemed medically stable and cleared for transfer to a subacute care nursing home for rehabilitation The patient understood from the neurologist in the hospital that the vertigo was secondary to the stroke and told it would eventually resolve She was on Meclizine for vertigo Upon physical therapy evaluation the patient was alert and oriented to person place time and situation The initial evaluation commenced at bedside The therapist asked if the patient could sit at the edge of the bed The patient attempted to sit but complained of vertigo while turning her head to her right side and immediately returned to a supine position After a brief rest period the vertigo subsided The patient reported that her vertigo usually lasts for a few minutes when she attempts to roll on the bed on either side She described her vertiginous symptoms as a spinning of the environment which is usually accompanied with nausea when she attempts to turn her head while lying supine The patient did not present with any focal neurological deficits Clinical Impression 1 The primary problem was identified as vertigo accompanied with nausea upon turning the head to either side in supine position The patient expressed extreme fear of falling secondary to vertigo When the patient turned her head to right side in supine position immediately she started complaining of vertigo and nausea

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