WordNet

undergo a test; "She doesnt test well"
any standardized procedure for measuring sensitivity or memory or intelligence or aptitude or personality etc; "the test was standardized on a large sample of students" (同)mental test, mental testing, psychometric test
the act of undergoing testing; "he survived the great test of battle"; "candidates must compete in a trial of skill" (同)trial
the act of testing something; "in the experimental trials the amount of carbon was measured separately"; "he called each flip of the coin a new trial" (同)trial, run
a hard outer covering as of some amoebas and sea urchins
put to the test, as for its quality, or give experimental use to; "This approach has been tried with good results"; "Test this recipe" (同)prove, try, try out, examine, essay
achieve a certain score or rating on a test; "She tested high on the LSAT and was admitted to all the good law schools"
determine the presence or properties of (a substance)
show a certain characteristic when tested; "He tested positive for HIV"
an examination of the characteristics of something; "there are laboratories for commercial testing"; "it involved testing thousands of children for smallpox"
the act of subjecting to experimental test in order to determine how well something works; "they agreed to end the testing of atomic weapons"
the 4th letter of the Roman alphabet (同)d
United States social reformer who pioneered in the reform of prisons and in the treatment of the mentally ill; superintended women army nurses during the American Civil War (1802-1887) (同)Dorothea Dix, Dorothea Lynde Dix
tested and proved useful or correct; "a tested method" (同)tried, well-tried
tested and proved to be reliable (同)time-tested, tried, tried and true

PrepTutorEJDIC

(人の能力などの)『試験』,考査,テスト / (物事の)『試験』,検済,試錬,実験《+of+名》 / 化学分析;試薬 / =test match / …‘を'『試験する』,検査する / …‘を'化学分析する / (…の)試験を受ける,試験をする《+for+名》
deuteriumの化学記号

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/19 13:23:31」(JST)

wiki en

The Dix–Hallpike test^[1] — or Nylen–Barany test — is a diagnostic maneuver used to identify benign paroxysmal positional vertigo (BPPV).^[2]

Process

The Dix–Hallpike test is performed with the patient sitting^[3] upright on the examination table with the legs extended. The patient's head is then rotated to one side by approximately 45 degrees. The clinician helps the patient to lie down backwards quickly with the head held in approximately 20 degrees of extension. This extension may either be achieved by having the clinician supporting the head as it hangs off the table or by placing a pillow under their upper back. The patient's eyes are then observed for about 45 seconds as there is a characteristic 5–10 second period of latency prior to the onset of nystagmus. If rotational nystagmus occurs then the test is considered positive for benign positional vertigo. During a positive test, the fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground. The direction of the fast phase is defined by the rotation of the top of the eye, either clockwise or counter-clockwise. Home devices are available to assist in the performance of the Dix–Hallpike Maneuver for patients with a diagnosis of BPPV.^[4]

Positive test

There are several key characteristics of a positive test:

Latency of onset (usually 5–10 seconds)
Torsional (rotational) nystagmus. If no torsional nystagmus occurs but there is upbeating or downbeating nystagmus, a central nervous system (CNS) dysfunction is indicated.
Upbeating or downbeating nystagmus. Upbeating nystagmus indicates that the vertigo is present in the posterior semicircular canal of the tested (lower ear) side. Downbeating nystagmus indicates that the vertigo is in the anterior semicircular canal of the contralateral (upper ear) side.
Fatigable nystagmus. Multiple repetition of the test will result in less and less nystagmus.
Reversal. Upon sitting after a positive maneuver the direction of nystagmus should reverse for a brief period of time.

To complete the test, the patient is brought back to the seated position, and the eyes are examined again to see if reversal occurs. The nystagmus may come in paroxysms and may be delayed by several seconds after the maneuver is performed.

Negative test

If the test is negative, it makes benign positional vertigo a less likely diagnosis and central nervous system involvement should be considered.

Advantages

Although there are alternative methods to administering the test, Cohen proposes advantages to the classic maneuver. The test can be easily administered by a single examiner, which prevents the need for external aid. Due to the position of the subject and the examiner, nystagmus, if present, can be observed directly by the examiner.^[5]

Limitations

The negative predictive value of this test is not 100%. Some patients with a history of BPPV will not have a positive test result. The estimated sensitivity is 79%, along with an estimated specificity of 75%.

The test may need to be performed more than once as it is not always easy to demonstrate observable nystagmus that is typical of BPPV. The test results can also be affected by the speed the maneuver is done in and the plane the occiput is in.^[6]

There are several disadvantages proposed by Cohen for the classic maneuver. Patients may be too tense, for fear of producing vertigo symptoms, which can prevent the necessary brisk passive movements for the test. A subject must have adequate cervical spine range of motion to allow neck extension, as well as trunk and hip range of motion to lie supine. From the previous point, the use of this maneuver can be limited by musculoskeletal and obesity issues in a subject.^[5]

Precautions and contraindications

In rare cases a patient may be unable or unwilling to participate in the Dix–Hallpike test due to physical limitations. In these circumstances the side-lying test or other alternative tests may be used.^[7]

Precautions

The Dix–Hallpike maneuver places a degree of stress on the patient’s lower back therefore a cautious approach must be taken with patients that are suffering from back pain.^[8]

Severe respiratory or cardiac problems may not allow a patient to tolerate the maneuver. For example a patient with orthopnoea may not be able to participate in the procedure as the patient may have troubling breathing when they lie down.^[8]

Absolute contraindications

Neck surgery^[8]
Severe rheumatoid arthritis^[8]
Atlantoaxial and occipitoatlantal instability^[8]
Aplasia of odontoid process^[8]
Cervical myelopathy^[8]
Cervical radiculopathy^[8]
Carotid sinus syncope^[8]
Vascular dissection syndromes^[8]

Footnotes

^ Dix MR, Hallpike CS (1952). "The pathology symptomatology and diagnosis of certain common disorders of the vestibular system" (Scanned & PDF). Proc. R. Soc. Med. 45 (6): 341–54. PMC 1987487. PMID 14941845.
^ Dix-Hallpike manoeuvre at Who Named It?
^ Karen H. Calhoun; David E. Eibling (13 January 2006). Geriatric otolaryngology. CRC Press. pp. 115–. ISBN 978-0-8247-2850-2. Retrieved 3 July 2011.
^ Beyea J, Wong E, Bromwich M, Weston W, Fung K. (2007). "Evaluation of a Particle Repositioning Maneuver Web-Based Teaching Modudle Using the DizzyFIX Device.". Laryngoscope 118: 175–180. doi:10.1097/mlg.0b013e31814b290d.
^ ^a ^b Cohen, H.S. (2004). "Side-Lying as an Alternative to the Dix-Hallpike Test of the Posterior Canal". Otology & Neurotology 25: 130–134. doi:10.1097/00129492-200403000-00008. PMID 15021771.
^ Bhattari H (2010). "Benign Paroxysmal Positional Vertigo: Present Perspective". Nepalese Journal of ENT Head and Neck Surgery 1 (2): 28–32.
^ Halker B, Barrs D, Wellik K, Wingerchuk D, Demaerschalk B. (2008). "Establishing a Diagnosis of Benign Paroxysmal Positional Vertigo Through the Dix-Hallpike and Side-Lying Maneuvers: A Critically Appraised Topic.". The Neurologist 14 (3): 201–204. doi:10.1097/NRL.0b013e31816f2820.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology 42 (3): 166–173. doi:10.3109/14992020309090426.

External links

Overview and diagrams at dizziness-and-balance.com
video of Dix-Hallpike test

UpToDate Contents

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1. 回転性めまい患者の評価 evaluation of the patient with vertigo
2. 浮動性めまい患者へのアプローチ approach to the patient with dizziness
3. 良性発作性頭位めまい症 benign paroxysmal positional vertigo
4. 小児および思春期における浮動性めまいの評価 evaluation of dizziness in children and adolescents
5. 回転性めまいの病態生理、病因、および鑑別診断 pathophysiology etiology and differential diagnosis of vertigo

English Journal

Periodic alternating nystagmus during caloric stimulation.

Taki M1, Hasegawa T2, Adachi N3, Fujita T4, Sakaguchi H5, Hisa Y5.
Auris, nasus, larynx.Auris Nasus Larynx.2014 Apr;41(2):211-4. doi: 10.1016/j.anl.2013.10.003. Epub 2013 Oct 30.
Periodic alternating nystagmus (PAN) is a form of horizontal jerk nystagmus characterized by periodic reversals in direction. We report a case who exhibited transient PAN induced by caloric stimulation. The patient was a 75-year-old male. He had experienced floating sensation in January 2010. Eight
PMID 24182689

Utility of Stepping, Walking, and Head Impulses for Screening Patients for Vestibular Impairments.

Cohen HS1, Sangi-Haghpeykar H, Ricci NA, Kampangkaew J, Williamson RA.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.Otolaryngol Head Neck Surg.2014 Mar 24. [Epub ahead of print]
OBJECTIVE: To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system.STUDY DESIGN: Sixty patients with vestibular disorders were compared with 60 asymptomatic controls.SETTING: Vestibular diagnostic laboratory, tertiary care center.SU
PMID 24664545

Sudden hearing loss with simultaneous posterior semicircular canal BPPV: possible etiology and clinical implications.

El-Saied S1, Joshua BZ2, Segal N2, Kraus M2, Kaplan DM2.
American journal of otolaryngology.Am J Otolaryngol.2014 Mar-Apr;35(2):180-5. doi: 10.1016/j.amjoto.2013.08.021. Epub 2013 Sep 21.
OBJECTIVES: The objectives of this study were to describe the clinical course and outcome of patients with sudden sensorineural hearing loss (SSNHL) in conjunction with benign paroxysmal positional vertigo (BPPV), and hypothesize the possible pathophysiology of this entity.STUDY DESIGN: Retrospectiv
PMID 24060342

Japanese Journal

後半規管BPPV short-arm型が疑われる症例の検討

重野浩一郎
Equilibrium Research 72(6), 485-492, 2013
… The present study included 39 patients with persistent vertical-torsional nystagmus triggered by the Head positional test, the Head positioning test and the Dix-Hallpike maneuver, suggesting pc-BPPV-cu or pc-BPPV short-arm-ca. …
NAID 130003395171

難治性良性発作性頭位めまい症と考えられた1例

犬飼賢也,高橋紳一郎,肥塚泉
Equilibrium research 70(1), 17-22, 2011-02-01
… The positional nystagmus test demonstrated apogeotropic nystagmus in a bilateral position with a duration of more than one minute. … Upbeat nystagmus with a clockwise direction (from the examiner) was seen in sitting position using the Dix-Hallpike method. … A caloric test did not show canal paresis. …
NAID 10029512141

頭位めまいにより発症した脊髄小脳変性症例

山本秀文,角南貴司子,栩野理恵,頭司隆史,住松律子,山根英雄,蔦田強司
Equilibrium research 63(3), 242-246, 2004-06-01
… And when he was underwent Dix-Hallpike maneuver, direction-changing torsional nystagmus was observed. … An eye-tracking test and an optokinetic pattern test, undergone after 1 month from the onset, showed impaired pursuit eye movement. … This case indicated that the eye-tracking test and optokinetic pattern test can be useful for the primary symptoms of the initial stage of SCA. …
NAID 10019205766

「眩暈」

Dix–Hallpike test
	Diagnostics
ICD-9-CM	95.46

　　[★]

日: げんうん、めまい
英: vertigo, dizziness
ラ: vertigo
同: めまい発作 dizzy spell
関: めまい、耳鳴り

めまいの分類

IMD. 276

回転性めまい vertigo：周囲または自分がぐるぐる回る、揺れる、傾くなどの回転感、傾斜、昇降感
浮動性めまい dizziness：体がふらつく、船に乗った感じという漠然とした浮遊感
faintness, black-out：目の前が暗くなる感じ(眼前暗黒感)、立ちくらみ感

SOD.134

回転性 vertigo
不安定性 dysequibrium
前失神 presyncope

原因部位による分類

めまいをきたしうる疾患

良性発作性頭位変換性めまい症
悪性発作性頭位変換性めまい症
前庭神経炎
突発性難聴
メニエール病
小脳・脳幹出血/梗塞
脳腫瘍
起立性低血圧

自律神経障害
椎骨脳底動脈血流不全
消化管出血

IMD.277

末梢前庭性めまい：メニエール病、良性発作性頭位めまい症、突発性難聴、内耳炎、前庭神経炎、外傷、薬物性前庭神経障害(アミノグリコシド、シスプラチンなど)
中枢性めまい：小脳梗塞、橋梗塞、小脳出血、橋出血、小脳炎、小脳腫瘍、橋腫瘍、聴神経腫瘍、椎骨脳底動脈循環不全、髄膜炎、アーノルド・キアリ奇形、多発性硬化症、脊髄小脳変性症、中毒性(フェニトイン]]、アルコールなど)、側頭葉てんかん、片頭痛
失神性めまい：起立性低血圧、シャイ・ドレーガー症候群、自律神経ニューロパチー(糖尿病、アミロイドーシス、特発性)、貧血、うっ血性心不全、弁膜症、高度徐脈、脱水、降圧薬の副作用
その他：心因性めまい、視性めまい、頚性めまい。多発神経炎・脊髄後索障害による深部知覚障害

原因部位と眼振

末梢性めまい：一部回旋性、水平性。疲労現象有り
中枢性めまい：水平性、垂直性、回旋性。注視方向性眼振。疲労現象無し

原因部位の鑑別

研修医当直御法度症例帳 p.22

	末梢性めまい	中枢性めまい
眼振	水平性	水平性
	回転性	回転性
		垂直性
耳鳴、難聴	○	稀
頭位	増強	軽度変化
カロリックテスト	陰性/低下	正常
意識消失	なし	あり
神経症状	稀	あり

IMD.279

	末梢前庭性めまい	中枢性めまい
性状	回転性が多い	回転性は少ない
強さ	強い	軽度
持続時間	数日まで	数日以上
眼振の方向	一方向性	注視方向性
自発眼振の性状	水平回旋性が多	純回旋性、垂直性
固視の影響	抑制される	抑制されない
注視眼振の増強する方向	健側	患側
蝸牛症状	多い	稀
中枢神経症候	なし	あり
悪心・嘔吐	軽度～重度	ない or 軽度

疫学

IMD.277

1. 末梢前庭性眩暈：4-5割　→　良性発作性頭位眩暈が多い。
2. 中枢性眩暈　　：3割

眩暈、難聴をきたす疾患

		前庭症状	蝸牛症状		特徴
		眩暈	難聴	耳鳴	特徴
薬剤性	ループ利尿薬	○	○	○	投与歴
薬剤性	アミノグリコシド系抗菌薬	○	○	○	投与歴
感染症	内耳炎	○	○	○
新生物	小脳橋角部腫瘍	○	○	○	CT, MRI異常
特発性	突発性難聴	△	○	○	単発
特発性	メニエール病	○	○	○	発作性、反復性
特発性	良性発作性頭位眩暈症	○	×		特定の頭位で発生。眩暈頭位の反復で減衰
炎症	前庭神経炎	○	×	×	単発