benign paroxysmal positional vertigo, recurrent vertigo and nystagmus occurring when the head is placed in certain positions. It can be debilitating and can cause difficulty in walking straight. It is usually not associated with central nervous system lesions. ▪ OBSERVATIONS: Patients may experience the sensation of disorientation in space combined with a sensation of motion accompanied by nystagmus, nausea and/or vomiting, perspiration, pallor, increased salivation, and general malaise. Diagnosis is made by history and clinical exam in conjunction with ENG and positional testing. Audiology, ABR, CT, or MRI may be used to rule out other causes of vertigo. ▪ INTERVENTIONS: Treatment is focused on a series of vestibular exercises, including gait training, sets of visual vestibular head and eye movements, Epley maneuvers, and Brandt-Daroff maneuvers. If exercises provoke nausea, premedication with antiemetics may be necessary. Surgical plugging of the posterior semicircular canal may be done in individuals with an intractable recurrent pattern of vertigo attacks that are unresponsive to exercise therapy. ▪ PATIENT CARE CONSIDERATIONS: Care focuses on demonstration and return demonstration of prescribed exercises.
