Benign Paroxsysmal Positional Vertigo (BPPV): An algorithm for clinicians
Dalton Gilligan, PT, DPT
Image retrieved from Riga, M., Korres, S., Korres, G., & Danielides, V. (2013). Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: Is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers. Otology & Neurotology, 00(00), 1-10.
​Sit to Supine (Aka Asprella Single Manoeuvre) (Gaglon, 2012; Riga et al., 2013)
Technique:
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1. Move patient from long sitting to supine, and observe for nystagmus.
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Riga. et. al., 2013 completed a review investigating treatment techniques and the accuracy of secondary diagnostic techniques. He determined that the Supine to Sit test overall had the highest sensitivity, lowest false negative ratio, and was the best secondary clinical sign for cupulolithiasis of the horizontal canal.
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​Geotropic Variant:
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In supine, horizontal component beats away from the side of involvement

Apogeotropic Variant:

Supine: Nystagmus beats towards affected ear
Spontaneous Nystagmus
When the horizontal canal is involved, a spontaneous nystagmus in sitting will sometimes appear. This may also assist the clinician in confirming the affected side.

Geotrophic Spontaneous Nystagmus
Sitting: Nystagmus beats opposite the direction of the affected ear

Apogeotropic Spontaneous Nystagmus
Sitting (spontaneous nystagmus): Nystagmus beats towards affected ear