The episodes lasted several seconds before resolving spontaneously. She complained of approximately 3 months of positional spinning sensation, worse with lying flat, or on her left side. Ī 77-year-old woman presented for otolaryngology consultation. This can be achieved through various canalith repositioning maneuvers, of which the most popular is the Epley maneuver.Īlthough certain forms of neck manipulation are felt to exacerbate ischemic strokes by cervical artery dissection, the Epley maneuver itself has strong evidence for safety and efficacy, with no serious adverse effects reported in the literature. Treatment of BPPV is primarily based on particle repositioning, by directing the canaliths into the utricle where they no longer stimulate the vestibular system. The diagnosis becomes definite when the Dix-Hallpike test elicits a fatiguable, reversible, torsional geotropic, paroxysmal nystagmus, accompanied by vertigo. This diagnosis is probable when the patients’ symptoms are reproduced with moving from sitting to a supine position, with the head in hanging position and turned 45° to the affected side. Although occasionally from secondary or acquired etiologies (as in post-trauma, vestibular neuritis, labyrinthitis, vertebrobasilar ischemia), the majority of cases are idiopathic in nature.īPPV diagnosis is typically confirmed by a Dix-Hallpike maneuver. The indirect causation and extreme rarity of this event do not warrant any change to patterns of practice.īenign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo associated with changes in head position, and is the most common vestibular disorder. This case, in which a patient experienced a hemorrhagic stroke after undergoing the Epley maneuver, is the first and sole case in the medical literature of an Epley-associated serious adverse event. The Epley maneuver is safe and effective, and there are no prior reports of serious adverse events associated with its use. After medical stabilization and rehabilitation, the patient continues to have a permanent visual field deficit.

A CT angiogram of the brain was performed urgently through the emergency department and demonstrated an acute intraparenchymal hemorrhage in the occipital lobe. Immediately following Epley maneuver, she had severe nausea and vomiting, with evolving visual changes. She was found to have BPPV clinically, and elected to have a particle repositioning maneuver (Epley maneuver) performed in clinic. Case presentationĪ 77 year old female presented for outpatient evaluation of vertigo at a tertiary otolaryngology clinic. This is the first case to our knowledge of a serious adverse event following the Epley maneuver, which is the treatment of choice for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder in adults.

Epley maneuver for vertigo mayo clinic