Hallpike Maneuver, Hallpike Test

Hallpike Maneuver, Hallpike Test

The Hallpike maneuver (Nylen-Bárány maneuver, positioning maneuver, Dix-Hallpike positioning test) is a test used in the investigation of vertigo to induce (or to modify) nystagmus by stimulating the otolith organs of the inner ear. It most usually consists of briskly tilting the patient’s head backward to 30-45° below the horizontal ("head hanging position") and turning it 45° to one side or the other, thus stimulating the posterior semicircular canal. Prior to performing the maneuver, the examiner should warn the patient that s/he may feel "giddy" or vertiginous, and to keep their eyes open throughout, since the development of nystagmus with the symptoms of vertigo is the observation of interest to the examiner. With a peripheral lesion (e.g., benign paroxysmal positional vertigo, diseases of the labyrinth), nausea, vomiting and rotational-vertical nystagmus occur several seconds after the maneuver and then rapidly fatigue (usually < 30 seconds), only to recur when the patient is returned to the upright position, with the nystagmus now in the opposite direction. Repetition of the maneuver (if the patient can be persuaded to undergo it) causes less severe symptoms (habituation). This is the diagnostic test for benign paroxysmal positional vertigo (BPPV). Central lesions (disorders of the vestibular connections) tend to produce isolated nystagmus which does not fatigue or habituate with repetition.
Variants of the Hallpike maneuver are described for BPPV of anterior or horizontal semicircular canal origin. Caloric testing may be required to elicit the causes of dizziness if the Hallpike maneuver is uninformative.

References

Bronstein AM. Vestibular reflexes and positional manoeuvres. Journalof Neurology, Neurosurgery and Psychiatry 2003; 74: 289-293
Dix MR, Hallpike CS. The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system. Proceedings ofthe Royal Society of Medicine 1952; 45: 341-354
Lanska DJ, Remler B. Benign paroxysmal positioning vertigo: classic descriptions, origins of the provocative positioning technique, and conceptual developments. Neurology 1997; 48: 1167-1177

Cross References

Caloric testing; Nystagmus; Vertigo; Vestibulo-ocular reflexes