What is the Hallpike maneuver and how is it used in the workup of vestibular neuronitis?

Updated: Jul 16, 2018
  • Author: Keith A Marill, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Perform the Hallpike maneuver on all patients who complain of vertigo but do not exhibit nystagmus on routine examination of the extraocular muscles.

Hallpike maneuver requires patient to lie back from sitting to supine position 3 times. The first time, have the patient lie back with the head facing forward and the neck slightly extended; repeat this movement with the patient's head turned 45 degrees to the right and a third time with the head turned 45 degrees to the left.

Instruct patient to keep both eyes open each time he or she lies back.

Check for nystagmus and ask patient about any symptoms of vertigo.

Among the characteristics of an elicited nystagmus that would suggest disease of peripheral origin are a pause before nystagmus appears (latency), unidirectional nystagmus, and fatiguing of nystagmus after approximately 1 minute or repeated inductions.

Failure either to observe or to provoke unidirectional nystagmus casts doubt on whether the process is localized to the peripheral vestibular system. Either finding suggests a need to consider other diagnostic alternatives.

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