dix-hallpike for post-traumatic BPPV - how soon is too soon?

[cadynz]

calling all vestibular whizzes!

i received a referral for a patient on ICU today (3.10.11) who came in after falling off a ladder onto the back of his head (30.9.11). CT showed a small sub arachnoid haemorrhage that they are managing conservatively.
he is improving clinically, independently mobile around the ICU, but his main problem is severe vertigo lasting less than a minute associated with head movement.
i am thinking post traumatic BPPV, but am reluctant to dix-hallpike him because of the potential for increased ICP.
the research i have found around contraindications for dix-hallpike mainly discussed cervical issues.

does anyone have an opinion/guidelines on when it is safe/appropriate to look at this type of testing in cases of TBI?

thanks! cady

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[psychophysio]

Sounds like it could be BPPV. Ask the docs if they mind if you do it and if they are OK with it, off you go! If they are not happy then you could look up , this article and follow the approach described within:

Does vertigo disappear only by rolling over? Rehabilitation for benign paroxysmal positional vertigo (2010) Acta Otolaryngol. 2010;130(1):84-8.

This approach involves lying supine, then head turn 90 degrees left for 10 sec, back to middle for 10 sec, then head turn to right for 10 sec. Repeat 10 times, twice per day for 2 weeks. It is a treatment manoeuvre, rather than diagnostic. They found similar rates of recovery at 2 weeks to those treated with an Epley's Manoeuvre.

Good luck