Assessing BPPV in a blind patient

[Gawaine]

interesting case... i would definitely clear the somatosensory system-- make sure his feet are still sending good signals up... no diabetes or other neuropathy? check the dix-hallpike again-- move him quick and relatively "deep"... i once had a lady who wasn't demonstrating a positive with my student until i took her down just a little faster...
if it's not BPPV but a non-descript vestibular balance disorder, standard balance training removing or decreasing somatosensory input would hopefully help him out... plus increasing the use of his somatosensory system and balance reactions should be good...


again, good luck with it!!

[psychophysio]

Well, it has been an interesting couple of weeks for my man....

He developed progressive left side weakness and sensory changes after last weekend. His hand power was 2/5 (5/5 on admission) & he developed some leg weakness too. He was reviewed by the rehab registrar to come down there and he queried a cervical spine lesion. One urgent MRI later we found a left C4-5 disc bulge with cord oedema.

The neurologist examined him and his impression was:
C4-5 disc bulge with Brown-Sequard pattern of stmptoms
Resolving vestibular neuronitis
Diabetic neuropathy

The patient had decompression surgery last week which was successful (halted progression of symptoms) and he is in rehab at the moment. I will keep an eye on how he does.

Thanks for your input and suggestions Patrick - he really is an interesting patient to assess and treat. In hindsight I wish that I did reflex testing with him as it would have been interesting to see if they were all intact on admission. I mnight dig out his notes and see what the doctors found.