Hallpike manoeuvre

A Hallpike Manoeuvre is a procedure that is performed to diagnose posterior canal BPPV when if the patient complains of vertigo (1), and is likely to alarm the patient unless they are warned about what is to happen.

• method
  • inform the patient that the procedure may provoke dizziness. There may be associated nausea and these will settle within 60 seconds
  • keep the patient seated upright (remove any eyeglasses if present)
  • the patient's head is turned 30 to 45 degrees to the side being tested
  • keep the patient eyes focused on your eyes
  • patient's head held and made to lie supine within about two seconds so that the neck lies hyperextended about 20 degrees past the horizontal plane with the patients chin pointing upwards slightly and the head hanging over the edge of the bed or table while the examiner supports the head (i.e.the bed)
  • eyes are observed for torsional nystagmus for up to 30 seconds
  • then the patient is slowly returned to the sitting position, a reversal of the nystagmus can be observed (1)
  • these steps should be repeated for the other ear as well to determine which ear is involved or if the condition is bilateral (1)
  • with repeated Hallpike Manoeuvre testing the nystagmus diminishes (it fatigues) (3)
    
    
• interpretations of the test (2)
  
  • horizontal nystagmus after a two- to 20-second latent period:
  • suggests a peripheral vestibular cause
    • e.g. benign paroxysmal positional vertigo (BPPV)
      
      
  • vertical nystagmus without a latent period:
    • suggests a central vestibular cause
      • e.g.posterior fossa tumor

Care should be taken when performing the test in the following patients:

• in patients with significant vascular disease – consider the risk of stroke or vascular disease
• cervical stenosis
• severe kyphoscoliosis
• spinal cord injuries
• limited cervical range of motion (1)

Click here for video of Hallpike manoeuvre

Reference:

• (1) Bhattacharyya N et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008;139(5 Suppl 4):S47-81
• (2) Labuguen RH. Initial Evaluation of Vertigo. American Family Physician 2006; 73 (2)
• (3) Lee SH, Kim JS. Benign paroxysmal positional vertigo. J Clin Neurol. 2010;6(2):51-63