Chronic positional vertigo

A 56 years female suffering from Chronic positional vertigo since 1 year. Not relieved by medications & Epley maneuver. Medications used are Vertin, Stemetil, Stugeron etc. MRI Brain Angiogram - Normal study What is the next step to do ... ? She is suffering a lot sir.

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All positional vertigo may not be BPPV. If it is BPPV conformed by Dix hallpike, fist have to identify canal. If it is PSCC epilies will work. Rarely expecially after trauma may get a LSCC BPPV in such cases epilies may not work sometimes and have to lembert 360 manauver. And pt may be relieved. Exercise may make pt symptom free 3 days to 2week. So usually repeat every week till symptoms disappears completely. Symptom free period more for PSCC and less for LSCC. Some may have relapses and may stay for years.

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First chek ear, for drum puncture,past history Blood investigation to rft,lft, blood sugar,lipid profile Digestive enzymes orally Relieve constipation if present Neck exercise , Refer ent for more investigation

First of all if it's positional it should have been relieved by epleys, secondly many of us don't do the epleys properly,it's necessary to do it properly otherwise it will not be of any use.Vestibular rehabilitation exercises should be started at once.If the symptoms are acute,they should be treated with vertin 48 mg OD ,only till acute episode subsides.The patient should be advised to sleep in a head elevated position by keeping 2 pillows.Avoidance of tea,coffee,salt restricted diet.Adequate hydration is necessary.

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Conium Mac 200 /od Theridon 30 /od

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