SUPINE ROLL TEST

Timothy C. Hain, MD • Page last modified: February 26, 2022

Also see: Dix-Hallpike Test. Lateral canal BPPV BPPV

The supine roll test is the definitive diagnostic test for Lateral Canal Benign Paroxysmal Positional Vertigo (LC-BPPV).
supine roll

This figure illustrates the Supine-Roll test for lateral canal BPPV. A person is brought from sitting to a supine position, with the head turned 90 degrees to one side and flexed about 20 degrees foreward. Once supine, the eyes are typically observed for about 30 seconds. Practically, a pillow can be used to maintain head flexion. The head is then rotated to the midline for 30 seconds, and then 90 degrees to the other side.

If the person has arthritis in their neck, the maneuver may be performed in side-lying position.

Figure from Helminski JO, Hain TC, 2007.

A positive Supine-Roll test consists of a burst of horizontal nystagmus (jumping of the eyes). In lateral canal BPPV, the eyes jump sideways, to opposite directions depending on the side that is down (this is called "direction changing"). As the eyes can either always jump down, or up with respect to gravity, this defines two variants -- "geotrophic" nystagmus (down), and "ageotrophic nystagmus" (up). The first is far more common.

The the geotrophic variant Lateral Canal type BPPV nystagmus is illustrated below. Other types of BPPV (PC, AC, Multicanal) have different patterns of nystagmus. The most common type of BPPV, posterior canal BPPV, is diagnosed with the Dix-Hallpike test. The Dix-Hallpike is also the diagnostic test for the anterior canal variant of BPPV.

There are a number of pieces of equipment that help greatly with doing the Supine-Roll test.

Frenzel Goggles:

Frenzel Goggles or video Frenzel goggles make the Supine-Roll test much more sensitive. Most doctors that specialize in seeing dizzy patients have these in their office.

Frenzel Goggles can be used to visualize the eyes during the Supine-Roll test. This is the optical type. Other types are described here.

 

More material about Frenzel goggles and video ENG goggles can be found here.

Mat table:

A mat table is very helpful during the Supine-Roll because it makes the process safer (the patient is closer to the ground).

A mat table (big blue thing) is very helpful in doing the Supine-Roll Test. A boat cushion can be seen underneath the table. This is handy to use as a pillow to keep the head flexed about 20-30 degrees.

Video-ENG

It is helpful to be able to print out a record of BPPV nystagmus during a Supine-Roll test. This enables the treating clinician to quantify response, and also is very helpful in situations where good documentation is essential (such as in medicolegal cases). The ENG system that we use in our clinical practice in Chicago is shown above (the computer system). Others are described here.

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