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% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (benign-paraoxysmal-positional-vertigo-bppv.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Benign Paraoxysmal Positional Vertigo (BPPV) Cheat Sheet)
}

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\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Benign Paraoxysmal Positional Vertigo (BPPV) Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/25897/}}}
\end{tabulary}
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\noindent
\begin{multicols}{3}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 9th November, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
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  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\raggedcolumns

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\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{BPPV}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vertigo - sensation of swaying, tilting, spinning or feeling unbalanced} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Vertigo can be benign or sinister} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Displacement of calcium carbonate crystals in the semicircular canals} \tn 
% Row Count 5 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- The crystals settle in the endolymph \{\{nl\}\} - No stimulus causing hair cells to fire \{\{nl\}\} - displaced crystals shift with the fluid \{\{nl\}\} Stimulus is unbalanced with respect to opposite ear \{\{nl\}\} - This causes symptoms of \seqsplit{dizziness/spinning/swaying}} \tn 
% Row Count 11 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Demographics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Can occur at any age, but common at the 4th and 5th decade} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Incidence increases over time because of the degenerative changes in the otolithic membrane (elderly can have falls)} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Slightly more common in females} \tn 
% Row Count 6 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Affects right labryrinth more commonly} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Sedentary lifestyle} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Nutritional deficiencies} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Hyperinsulinemia} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Hyperglycemia} \tn 
% Row Count 4 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Ear Anatomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1609327468_ear.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Filled with endolymph , endolymph bends cilia , movement of these cilia sends signals to brain \newline - Transmits to eyes and cervical proprioceptors \newline - Superior semicircular canal detects nodding movement  \newline - Horizontal semicircular - right and left head rotation \newline - Posterior semicircular - Movement in coronal plane(lat flexion of head)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Usually idiopathic (calcium carbonate particles dislodge and migrate into semicircular canals)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Cranial Trauma} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Prior otological surgery} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Infection} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vestibular neuritis} \tn 
% Row Count 6 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Middle ear disease} \tn 
% Row Count 7 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Menieres} \tn 
% Row Count 8 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Ovarian hormonal dysfunction} \tn 
% Row Count 9 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Ototoxicity} \tn 
% Row Count 10 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Endolymphatic hydrops} \tn 
% Row Count 11 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Syphilis} \tn 
% Row Count 12 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Psychological disorders} \tn 
% Row Count 13 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vestibular system degeneration} \tn 
% Row Count 14 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Metabolic disorders} \tn 
% Row Count 15 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- CV disease} \tn 
% Row Count 16 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Vertobrobasilar insufficiency} \tn 
% Row Count 17 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vertebral artery stenosis and tortuosity} \tn 
% Row Count 18 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Sudden episodes of rotatory vertigo} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Usually lasts 10-20 seconds after head position change} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Usually occurs during moving from upright to lying down. rolling from side to side in bed, bending forward, moving head to look up and downor side to side} \tn 
% Row Count 7 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Usually occurs with increased anxiety, impaired postural control, reduced quality of life} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Rule out more sinister causes of vertigo/dizziness} \tn 
% Row Count 11 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Pinpoint site of involved canal (multiple can be involved and it can occur bilaterally)} \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Most cases affect posterior semicircular canal} \tn 
% Row Count 14 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- +ve Dixhallpike ( for posterior reproduction of dizziness, nausea, and or upbeating rotary nystagmus (pupils move counterclockwise in right labryrinth lesions and clockwise in left) - Downward facing ear one being tested} \tn 
% Row Count 19 (+ 5)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- +ve supine roll test (for horizontal canal)} \tn 
% Row Count 20 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Anterior canal is rare due to it's upright orientation (debris likely to fall out)} \tn 
% Row Count 22 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Imaging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{MRI and CT/Not BPPV if:}} \{\{nl\}\} Negative Dix-hallpike or supine roll \{\{nl\}\}Abnormal cranial exam findings \{\{nl\}\} Nystagmus (Vertical, torsional, direction-changing, non-fatigable - central cause) \{\{nl\}\}Continuous symptoms \{\{nl\}\}  Head trauma \{\{nl\}\}Vertigo occurs without changing head positions \{\{nl\}\} Loss of conciousness \{\{nl\}\} Frequent unexplained falls \{\{nl\}\} Recent viral infection \{\{nl\}\} Hearing loss \{\{nl\}\} Tinnitus \{\{nl\}\} Ear fullness \{\{nl\}\} Earache \{\{nl\}\} Ptosis \{\{nl\}\} Facial/extremity paraesthesia \{\{nl\}\} Visual disturbances \{\{nl\}\} Difficulty swalling/speaking \{\{nl\}\} Ataxia \{\{nl\}\} medications \seqsplit{(anti-hypertensive/anti-depressants)}} \tn 
% Row Count 13 (+ 13)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- This is to rule out other pathologies} \tn 
% Row Count 14 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Cervicogenic vertigo (similar to BPPV, patient complains of \seqsplit{floating/lightheadness/unsteadiness}, presents with loss of Cx ROM, Cx restrictions and tenderness +ve neck torsion test - stimulates cx proprioceptors)} \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Concussion (Trauma)} \tn 
% Row Count 6 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Intracranial Bleed (UMNL)} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- CNS ischemia/stroke/VBAI ( Gait, Ataxia, Rhomberg, coordinationother symptoms, Cranial nerves, blood pressure)} \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Neoplasm (Lymphnodes, systemic signs)} \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Infection (Temperature, Otoscopic exam, Lymph nodes)} \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Intracranial swelling} \tn 
% Row Count 14 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Migraine} \tn 
% Row Count 15 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Carotid sinus syndrome (Auscultation of carotid)} \tn 
% Row Count 16 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Intoxication} \tn 
% Row Count 17 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Menieres} \tn 
% Row Count 18 (+ 1)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Perilymphatic fistula} \tn 
% Row Count 19 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Vestibular system degeneration} \tn 
% Row Count 20 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- CV disease (Heart and Respiratory exam)} \tn 
% Row Count 21 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Drug toxicity} \tn 
% Row Count 22 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Cerebellopontine angle neoplasm} \tn 
% Row Count 23 (+ 1)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Brainstem encephalitis} \tn 
% Row Count 24 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Canalith repositioning and home exercises for appropriate semicircular canal} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- If posterior, Epley maneuver or Foster Half somersault} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- If horizonal canal, Lempert 360 roll maneuver (BBQ roll)} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- If anterior, Epley/reverse epley} \tn 
% Row Count 7 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Inform patients that they might feel dizzy, attempt to keep their eyes open as much as possible (look at my nose)} \tn 
% Row Count 10 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Inform patients to sleep with the affected side up and reaccurance rates (10 and 80\% - delay between symptom and management leads to higher occurance rates) and safety} \tn 
% Row Count 14 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- If CNS/balance disorders - additional home support to reduce risk of falling} \tn 
% Row Count 16 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Home exercises: Brandt-Daroff exercises, Foster half somersault, Eye tracking} \tn 
% Row Count 18 (+ 2)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- {\bf{Contraindications:}} Acute Cx F\#/instability, recent cx spine surgery, perilymph fistula, Detached retina, Unstable carotid artery disease/stenosis, Vertebrobasilar insuffciency, Stroke/TIA, Unstable Heart disease, Severe neck disease (Cervical spondylosis +myelopathy, Advanced RA} \tn 
% Row Count 24 (+ 6)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Cx SMT} \tn 
% Row Count 25 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Antihistamines (Meclizine) suppress labryrinth excitability and vestibular-end organ receptors} \tn 
% Row Count 27 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Anti-emetics (ondansetron, metoclopramide, \seqsplit{promethazine/prochlorperazine)}} \tn 
% Row Count 29 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Prognosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Most pts find relief within 4-6 weeks} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Recurrence rates 5-25\%} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Risk of recurrence: Females, older patients, psychiatric} \tn 
% Row Count 4 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}