Resolution of severe vertigo in a remote location by the modified Epley maneuver

Benign paroxysmal positional vertigo (bppv) is an extremely common cause of peripheral vertigo. bppv is believed to be caused by the presence of tiny crystals in the semicircular canals. it is typically diagnosed from a patient's history and examination. a 55-year-old lady dialed the emergency services due to severe vertigo and vomiting for about two hours. the previous night she travelled around 250 miles in her caravan to north wales,uk,for a holiday. no ambulance was available to be dispatched,hence the ambulance control contacted the local general practitioner doctor on duty to attend to the patient. the patient was suffering from recurrent vertigo symptoms for nearly two years,despite being on medications. she described her symptoms as room spinning when she wanted to get out of the bed which was associated with vomiting. history and examination revealed no signs attributing to acute stroke. after performing the dix-hallpike test,the doctor confirmed the diagnosis of posterior canal bppv and the patient was offered the modified epley maneuver. post-maneuver,a significant improvement in her symptoms was noticed within a few minutes. on arrival of ambulance crew after an hour,the patient decided not to go to hospital as her symptoms were almost 90 percent better. this case highlights the need for awareness among family medicine and emergency doctors to diagnose and treat bppv with a physical maneuver rather than medications. ©2014 bashir tariq irfan pathan licensee bloomsbury qatar.