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Papers by Ajay Kumar Vats

Research paper thumbnail of Apogeotropic Posterior Semicircular Canal BPPV—A Case Series from South Rajasthan

Annals of Indian Academy of Neurology

Apogeotropic variant of posterior semicircular canal benign paroxysmal positional vertigo (apo-PS... more Apogeotropic variant of posterior semicircular canal benign paroxysmal positional vertigo (apo-PSC-BPPV) is a rare peripheral vestibular disorder, characterized by paroxysms of positionally triggered dizzy spells associated with non-positional disequilibrium. It is diagnosed by observing characteristic diagnostic oculomotor responses (torsional downbeating positional nystagmus) during positional testing (Dix-Hallpike and enhanced straight head hanging tests), in conjunction with a response to physical therapy. Much rarer anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) elicits identical oculomotor responses during positional testing. Propter hoc, response to physical therapy at short-term follow-up is crucial in distinguishing the apo-PSC-BPPV from ASC-BPPV. We are presenting a case series of seven patients of apo-PSC-BPPV (of which three were bilaterally affected), who attended our otoneurology center, between February 1, 2023, and July 31, 2023. Demograp...

Research paper thumbnail of Side lying test for anterior semicircular canal benign paroxysmal positional vertigo

Annals of Indian Academy of Neurology, 2021

Annals of Indian Academy of Neurology ¦ Volume 25 ¦ Issue 1 ¦ January‐February 2022 148 IntRoduct... more Annals of Indian Academy of Neurology ¦ Volume 25 ¦ Issue 1 ¦ January‐February 2022 148 IntRoductIon The diagnosis, localization, and lateralization of the involved semicircular canal (SCC) in benign paroxysmal positional vertigo (BPPV) are solitarily dependent on the oculomotor patterns of nystagmus elicited on the diagnostic positional tests: Dix‐Hallpike test (DHT) for the vertical canals (posterior and anterior semicircular canals) and supine roll test for horizontal semicircular canal. After following observations in 100 patients, Dix and Hallpike[1] (1952) propounded a symptomatic definition and a provocative positional test, which they referred to as “positional nystagmus of benign positional type.” In the maneuver innovated by them, the patient was first seated upon the examination couch with his head turned to one side and the gaze fixed firmly on the examiner’s forehead. Thereupon, the examiner would grasp the patient’s forehead firmly between his hands and briskly push the patient back into the critical position 30° below the level of the couch and subsequently turn the head approximately 30°–45° to one side. They noted torsional nystagmus with the upper pole of the eyes beating toward the ground and on retesting, this response fatigued. Response latency of approximately 5s with a crescendo‐decrescendo type of nystagmus and its reversal as the patient sits up was also observed. The DHT now in use, as per the clinical practice guidelines of the American Academy of Otolaryngology, Head, and Neck Surgery Foundation, recommends taking the head 20° below the level of the examination table instead.[2] The DHT orients the vertical canals (posterior and anterior semicircular canals) in a manner that the ampullary end of the canal displaces to a relatively superior location facilitating the excitatory ampullofugal movement of the otoconial debris. The ampullofugal cupular deflection during the DHT generates the excitatory impulses in the posterior [in posterior semicircular canal‐BPPV (PSC‐BPPV)] and anterior (in ASC‐BPPV) ampullary nerves resulting in the diagnostic oculomotor patterns (upbeating in PSC‐BPPV, downbeating in ASC‐BPPV; ipsitorsional in either case). The DHT is difficult to perform in patients with a limited cervical range of motion in the pitch plane, and those with obesity, fear, and musculoskeletal limitations. In addition, the biomechanics of the DHT has the potential to strain the back region of the clinician.

Research paper thumbnail of Case report: Congenital absence of the dens

Indian Journal of Radiology and Imaging, 2010

A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MR... more A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MRI revealed absence of the odontoid process of the C2 vertebral body, with resultant atlantoaxial dislocation along with myelomalacic changes involving the cervicomedullary junction.

Research paper thumbnail of A rare case of Charlin's syndrome

Journal of Indian Academy of Oral Medicine and Radiology, 2017

Charlin's syndrome is an extremely rare condition characterized by pain in the nasal and para... more Charlin's syndrome is an extremely rare condition characterized by pain in the nasal and paranasal areas, which is precipitated by touching the lateral aspect of the ipsilateral nostril. We are presenting one such case of a 42-year-old man who was admitted to Dr. Chaudhary Hospital and Medical Research Centre.

Research paper thumbnail of Lying-Down Nystagmus (LDN) – When a Lateralizing Sign of Secondary Importance Attains Ascendancy in the Diagnosis of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo (HSC-BPPV)

Medknow Publications, 2021

Background: The diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo (... more Background: The diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) mainly depends on the elicitation of asymmetric horizontal positional nystagmus on rolling head to either side, during the diagnostic supine roll test (SRT). The asymmetry in the strength of the elicited horizontal positional nystagmus during SRT is explained by the Ewald's second law and is crucial for lateralizing the affected ear. Rarely the elicited horizontal positional nystagmus on the head roll to either side during the SRT is of symmetric strength. In such situations, the signs with secondary lateralizing value are useful in management by the repositioning maneuvers that require the affected side to be precisely known. Aim: The submitted article is a case report. Results and Discussion: A 38-year-old male with two days history of vertigo on rolling to either of the lateral recumbent position was seen in the second week of March 2019. His SRT elicited a lying-down ny...

Research paper thumbnail of Left DIX-Hallpike Test in a Patient of Left Type-III DRS

The Dix-Hallpike test on the right side was performed by making the patient sit on the examinatio... more The Dix-Hallpike test on the right side was performed by making the patient sit on the examination couch with both lower limbs placed along the long axis of the couch. A pillow 4-inch-thick pillow was placed behind her buttocks to be used as vantage point instead of using the end edge of the couch, during the test. Her head was rotated 45 degrees to her right in the yaw plane and she was taken to supine position so that her head got extended 30-degrees as she was laid. Right Dix-Hallpike test elicited a positioning nystagmus, which was upbeating and excyclotorsional in the normal right eye and upbeating without torsional component in diseased left eye.

Research paper thumbnail of Brainstem Evoked Potentials in the Idiopathic Parkinson's Disease (PD)

Annals of Indian Academy of Neurology, 2021

Research paper thumbnail of Lying down nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV)

Research paper thumbnail of A Young Patient with Horizontal Semicircular Cupulolithiasis with Immediate Response to the Therapeutic Head-Shaking Maneuver (HSM)

Annals of Otology and Neurotology

The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo is... more The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo is attributed to either short anterior ampullary arm canalolithiasis or to the cupulolithiasis with the otoconial debris adhering to the cupula on utricular (Cup-U) or canal side (Cup-C), rendering it heavy and gravity sensitive. The treatment options for horizontal semicircular cupulolithiasis are not very well defined. A 25-year-old female patient with 8 days history of vertigo on rolling to either of the lateral recumbent position presented in the first week of November 2019. The supine roll test (SRT) on yawing head maximally to the right as well as to the left elicited an apogeotropic horizontal positional nystagmus lasting more than 1 minute, which was stronger on the right side and indicated a diagnosis of left horizontal semicircular cupulolithiasis. Two short-term follow-ups at 1 and 24 hours after head-shaking maneuver (HSM), with verifying SRT, were undertaken. During either of ...

Research paper thumbnail of Unilateral Multicanalicular Vestibular Lithiasis of Right Horizontal and Posterior Semicircular Canals: An Unusual Case

Annals of Otology and Neurotology

Vestibular lithiasis (canalolithiasis as well as cupulolithiasis) commonly exists in monocanalicu... more Vestibular lithiasis (canalolithiasis as well as cupulolithiasis) commonly exists in monocanalicular forms involving one of the three semicircular canals, frequent posterior, less frequent horizontal, and very rarely anterior. It is treated with canal clearing maneuvers intended to reposition the otoconia from the semicircular canal (where they have inappropriately entered) through the utricular exit in the nonampullary arm of the semicircular canal to the utricle (where they normally remain as a part of utricular gelatinous matrix). The cases of multicanalicular vestibular lithiasis with the involvement of more than one semicircular canal require meticulous identification of the involved canals and multiple different canal-clearing maneuvers for effective treatment. A 70-year-old male patient with no significant history of previous medical or otologic illnesses or head trauma presented with a 1-day history of vertigo with positional aggravation. A one-time performed diagnostic supi...

Research paper thumbnail of Physical Therapy for the Horizontal Semicircular Cupulolithiasis: A Prospective Interventional Case Series from an Otoneurology Center in South Rajasthan, India

Annals of Otology and Neurotology

Objective This article aims to study the effect of physical therapy in patients of horizontal sem... more Objective This article aims to study the effect of physical therapy in patients of horizontal semicircular cupulolithiasis with results audited in the short term. Design Nonrandomized prospective interventional study. Study Sample Four patients with horizontal semicircular cupulolithiasis. Results All four patients in whom diagnostic supine roll test (carried at least thrice to look for the sustainability as well as the polarity of the nystagmus) elicited apogeotropic horizontal positional nystagmus lasting more than 1 minute were subjected to therapeutic head-shaking maneuver (HSM). The results were audited immediately after the physical therapy, and at 1 hour. Follow-up by telephonic interviews for 4 weeks was done in all patients. Three out of four patients responded to HSM alone. One patient who did not respond to HSM was successfully treated with four other sequent physical therapies. Conclusion The response of physical therapy for horizontal semicircular cupulolithiasis occasi...

Research paper thumbnail of The Clinical Spectrum of Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo Attending an Otoneurology Center in South Rajasthan, India and Their Response to Appropriate Repositioning Maneuvers at a Short-Term Follow-Up

Annals of Otology and Neurotology

Introduction This article aims to study the clinical spectrum of 20 consecutive patients diagnose... more Introduction This article aims to study the clinical spectrum of 20 consecutive patients diagnosed with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) attending an otoneurology center in Udaipur, Rajasthan, India, over a period of 11 months and their response to appropriate repositioning maneuvers evaluated at short-term follow-up of 1 hour and 24 hours. Study Design This is a nonrandomized prospective interventional study. Materials and Methods Twenty patients with unilateral HSC-BPPV were treated with a session of an appropriate repositioning maneuver (Gufoni maneuver or barbecue roll maneuver for the geotropic variant of HSC-BPPV [geo-HSC-BPPV]; Appiani maneuver or barbecue roll maneuver or head-shaking maneuver for the apogeotropic variant of the HSC-BPPV [apo-HSC-BPPV]). Patients were followed up twice (at 1 hour and 24 hours) and audited by a supine roll test with questioning for the absence or presence of concomitant vertigo. Results At the 1-ho...

Research paper thumbnail of A case of apogeotropic horizontal canal benign paroxysmal positional vertigo that transformed to the geotropic variant during treatment with Appiani maneuver, followed by successful treatment with Gufoni maneuver

Physiotherapy Theory and Practice

Research paper thumbnail of Lack of Torsion in the Type-III Duane Retraction Syndrome (DRS-III) Affected Left Eye During Dix -Hallpike Test

Annals of Otology and Neurotology

Background Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder (CCDD)... more Background Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder (CCDD) of ocular movements, characterized by deficits in horizontal duction associated with narrowing of palpebral fissure, retraction of eye globe on attempted adduction and occasionally accompanied by upshoot or downshoot of the eye globe. It is caused by congenital absence of sixth cranial nerve, which results in fibrotic changes in the extraocular muscles leading to an abnormal ocular motility--a concept known as CCDD. Depending on whether only abduction/adduction or both are affected, DRS has been classified into three types designated as type-I, type-II and type-III. The torsional movements of the affected eye in DRS have not been reported to be deficient hitherto, which could be due to difficulties in the routine bedside evaluation of such movements. Case Presentation An unusual case of a patient of left unilateral type-III DRS is reported, who presented with a short history of vertigo ...

Research paper thumbnail of A Case of Right Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo with to-and-fro Canal Switch to Right Horizontal Semicircular Canal

Annals of Otology and Neurotology

Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositionin... more Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositioning maneuvers (CRM), when there is a reflux of the repositioned otoconial debris from utricle to semicircular canal other than the one originally affected. It may be of immediate-type occurring within minutes after CRM or a delayed-type occurring after 2-3 days. Aim The study is a case report. Case Report A 59-year-old female presented with history of severe rotational vertigo as she got up from the bed in the early morning at 5.00 a.m.. Dix-Hallpike test (DHT) on the right elicited an upbeating positional nystagmus (PN). Treatment with multiple consecutive modified right Epley maneuvers (r-MEM) in one session was undertaken. During these maneuvers she continued to have an upbeating PN during the 45-degrees right cervical rotation with the neck in 20-degrees of extension (which is equivalent to right Dix-Hallpike positioning) of the first three sequential r-MEM’s. With the neck maintained ...

Research paper thumbnail of Unveiling Positioning Nystagmus in Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo by Diagnostic Head-Shaking in the Yaw Plane

Annals of Otology and Neurotology

Background The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on e... more Background The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on elicitation of positioning nystagmus on the diagnostic positional tests, namely Dix-Hallpike and supine roll tests (DHT and SRT, respectively), in patients complaining of vertigo, which occurs when patient's head moves relative to the gravity. The pattern of elicited positioning nystagmus localizes as well as lateralizes the diseased canal, and the therapeutic positioning maneuver is accordingly undertaken. Aim The diagnostic positional tests, at times fail to elicit positional nystagmus, leaving clinician in a state of dilemma, when examining a patient who is currently experiencing paroxysms of vertigo triggered by positional change. In two patients with history consistent with BPPV but with negative positional tests initially, head shaking for 10 seconds in the yaw axis was done, and Dix-Hallpike and supine roll tests were repeated. The aim of head shaking for 10 seconds was to unve...

Research paper thumbnail of Kawasaki disease—Indian perspective

The Indian Journal of Pediatrics, 2001

Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is... more Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is a leading cause of acquired heart disease in many developed countries. Incidence of this disease in India is extremely low as evidenced by the meagre case reports. Complications due to this disease in Indian patients are still rarer. Here we report two cases of Kawasaki disease both of whom had a benign course. A comparison of this disease in Indian and Western literature shows that the incidence of cardiac complications in the Indian patients is about 10% while in the west it is reported at around 30%. This paucity of complications in the Indian patients may be the reason of poor reporting of this disease in our country.

Research paper thumbnail of A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

Annals of Otology and Neurotology

In any patient with a history of rotational vertigo triggered by changes in the position of head ... more In any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnos...

Research paper thumbnail of A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

Annals of Otology and Neurotology

In any patient with a history of rotational vertigo triggered by changes in the position of head ... more In any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnos...

Research paper thumbnail of Case report: Congenital absence of the dens

Indian Journal of Radiology and Imaging, 2010

A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MR... more A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MRI revealed absence of the odontoid process of the C2 vertebral body, with resultant atlantoaxial dislocation along with myelomalacic changes involving the cervicomedullary junction.

Research paper thumbnail of Apogeotropic Posterior Semicircular Canal BPPV—A Case Series from South Rajasthan

Annals of Indian Academy of Neurology

Apogeotropic variant of posterior semicircular canal benign paroxysmal positional vertigo (apo-PS... more Apogeotropic variant of posterior semicircular canal benign paroxysmal positional vertigo (apo-PSC-BPPV) is a rare peripheral vestibular disorder, characterized by paroxysms of positionally triggered dizzy spells associated with non-positional disequilibrium. It is diagnosed by observing characteristic diagnostic oculomotor responses (torsional downbeating positional nystagmus) during positional testing (Dix-Hallpike and enhanced straight head hanging tests), in conjunction with a response to physical therapy. Much rarer anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) elicits identical oculomotor responses during positional testing. Propter hoc, response to physical therapy at short-term follow-up is crucial in distinguishing the apo-PSC-BPPV from ASC-BPPV. We are presenting a case series of seven patients of apo-PSC-BPPV (of which three were bilaterally affected), who attended our otoneurology center, between February 1, 2023, and July 31, 2023. Demograp...

Research paper thumbnail of Side lying test for anterior semicircular canal benign paroxysmal positional vertigo

Annals of Indian Academy of Neurology, 2021

Annals of Indian Academy of Neurology ¦ Volume 25 ¦ Issue 1 ¦ January‐February 2022 148 IntRoduct... more Annals of Indian Academy of Neurology ¦ Volume 25 ¦ Issue 1 ¦ January‐February 2022 148 IntRoductIon The diagnosis, localization, and lateralization of the involved semicircular canal (SCC) in benign paroxysmal positional vertigo (BPPV) are solitarily dependent on the oculomotor patterns of nystagmus elicited on the diagnostic positional tests: Dix‐Hallpike test (DHT) for the vertical canals (posterior and anterior semicircular canals) and supine roll test for horizontal semicircular canal. After following observations in 100 patients, Dix and Hallpike[1] (1952) propounded a symptomatic definition and a provocative positional test, which they referred to as “positional nystagmus of benign positional type.” In the maneuver innovated by them, the patient was first seated upon the examination couch with his head turned to one side and the gaze fixed firmly on the examiner’s forehead. Thereupon, the examiner would grasp the patient’s forehead firmly between his hands and briskly push the patient back into the critical position 30° below the level of the couch and subsequently turn the head approximately 30°–45° to one side. They noted torsional nystagmus with the upper pole of the eyes beating toward the ground and on retesting, this response fatigued. Response latency of approximately 5s with a crescendo‐decrescendo type of nystagmus and its reversal as the patient sits up was also observed. The DHT now in use, as per the clinical practice guidelines of the American Academy of Otolaryngology, Head, and Neck Surgery Foundation, recommends taking the head 20° below the level of the examination table instead.[2] The DHT orients the vertical canals (posterior and anterior semicircular canals) in a manner that the ampullary end of the canal displaces to a relatively superior location facilitating the excitatory ampullofugal movement of the otoconial debris. The ampullofugal cupular deflection during the DHT generates the excitatory impulses in the posterior [in posterior semicircular canal‐BPPV (PSC‐BPPV)] and anterior (in ASC‐BPPV) ampullary nerves resulting in the diagnostic oculomotor patterns (upbeating in PSC‐BPPV, downbeating in ASC‐BPPV; ipsitorsional in either case). The DHT is difficult to perform in patients with a limited cervical range of motion in the pitch plane, and those with obesity, fear, and musculoskeletal limitations. In addition, the biomechanics of the DHT has the potential to strain the back region of the clinician.

Research paper thumbnail of Case report: Congenital absence of the dens

Indian Journal of Radiology and Imaging, 2010

A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MR... more A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MRI revealed absence of the odontoid process of the C2 vertebral body, with resultant atlantoaxial dislocation along with myelomalacic changes involving the cervicomedullary junction.

Research paper thumbnail of A rare case of Charlin's syndrome

Journal of Indian Academy of Oral Medicine and Radiology, 2017

Charlin's syndrome is an extremely rare condition characterized by pain in the nasal and para... more Charlin's syndrome is an extremely rare condition characterized by pain in the nasal and paranasal areas, which is precipitated by touching the lateral aspect of the ipsilateral nostril. We are presenting one such case of a 42-year-old man who was admitted to Dr. Chaudhary Hospital and Medical Research Centre.

Research paper thumbnail of Lying-Down Nystagmus (LDN) – When a Lateralizing Sign of Secondary Importance Attains Ascendancy in the Diagnosis of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo (HSC-BPPV)

Medknow Publications, 2021

Background: The diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo (... more Background: The diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) mainly depends on the elicitation of asymmetric horizontal positional nystagmus on rolling head to either side, during the diagnostic supine roll test (SRT). The asymmetry in the strength of the elicited horizontal positional nystagmus during SRT is explained by the Ewald's second law and is crucial for lateralizing the affected ear. Rarely the elicited horizontal positional nystagmus on the head roll to either side during the SRT is of symmetric strength. In such situations, the signs with secondary lateralizing value are useful in management by the repositioning maneuvers that require the affected side to be precisely known. Aim: The submitted article is a case report. Results and Discussion: A 38-year-old male with two days history of vertigo on rolling to either of the lateral recumbent position was seen in the second week of March 2019. His SRT elicited a lying-down ny...

Research paper thumbnail of Left DIX-Hallpike Test in a Patient of Left Type-III DRS

The Dix-Hallpike test on the right side was performed by making the patient sit on the examinatio... more The Dix-Hallpike test on the right side was performed by making the patient sit on the examination couch with both lower limbs placed along the long axis of the couch. A pillow 4-inch-thick pillow was placed behind her buttocks to be used as vantage point instead of using the end edge of the couch, during the test. Her head was rotated 45 degrees to her right in the yaw plane and she was taken to supine position so that her head got extended 30-degrees as she was laid. Right Dix-Hallpike test elicited a positioning nystagmus, which was upbeating and excyclotorsional in the normal right eye and upbeating without torsional component in diseased left eye.

Research paper thumbnail of Brainstem Evoked Potentials in the Idiopathic Parkinson's Disease (PD)

Annals of Indian Academy of Neurology, 2021

Research paper thumbnail of Lying down nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV)

Research paper thumbnail of A Young Patient with Horizontal Semicircular Cupulolithiasis with Immediate Response to the Therapeutic Head-Shaking Maneuver (HSM)

Annals of Otology and Neurotology

The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo is... more The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo is attributed to either short anterior ampullary arm canalolithiasis or to the cupulolithiasis with the otoconial debris adhering to the cupula on utricular (Cup-U) or canal side (Cup-C), rendering it heavy and gravity sensitive. The treatment options for horizontal semicircular cupulolithiasis are not very well defined. A 25-year-old female patient with 8 days history of vertigo on rolling to either of the lateral recumbent position presented in the first week of November 2019. The supine roll test (SRT) on yawing head maximally to the right as well as to the left elicited an apogeotropic horizontal positional nystagmus lasting more than 1 minute, which was stronger on the right side and indicated a diagnosis of left horizontal semicircular cupulolithiasis. Two short-term follow-ups at 1 and 24 hours after head-shaking maneuver (HSM), with verifying SRT, were undertaken. During either of ...

Research paper thumbnail of Unilateral Multicanalicular Vestibular Lithiasis of Right Horizontal and Posterior Semicircular Canals: An Unusual Case

Annals of Otology and Neurotology

Vestibular lithiasis (canalolithiasis as well as cupulolithiasis) commonly exists in monocanalicu... more Vestibular lithiasis (canalolithiasis as well as cupulolithiasis) commonly exists in monocanalicular forms involving one of the three semicircular canals, frequent posterior, less frequent horizontal, and very rarely anterior. It is treated with canal clearing maneuvers intended to reposition the otoconia from the semicircular canal (where they have inappropriately entered) through the utricular exit in the nonampullary arm of the semicircular canal to the utricle (where they normally remain as a part of utricular gelatinous matrix). The cases of multicanalicular vestibular lithiasis with the involvement of more than one semicircular canal require meticulous identification of the involved canals and multiple different canal-clearing maneuvers for effective treatment. A 70-year-old male patient with no significant history of previous medical or otologic illnesses or head trauma presented with a 1-day history of vertigo with positional aggravation. A one-time performed diagnostic supi...

Research paper thumbnail of Physical Therapy for the Horizontal Semicircular Cupulolithiasis: A Prospective Interventional Case Series from an Otoneurology Center in South Rajasthan, India

Annals of Otology and Neurotology

Objective This article aims to study the effect of physical therapy in patients of horizontal sem... more Objective This article aims to study the effect of physical therapy in patients of horizontal semicircular cupulolithiasis with results audited in the short term. Design Nonrandomized prospective interventional study. Study Sample Four patients with horizontal semicircular cupulolithiasis. Results All four patients in whom diagnostic supine roll test (carried at least thrice to look for the sustainability as well as the polarity of the nystagmus) elicited apogeotropic horizontal positional nystagmus lasting more than 1 minute were subjected to therapeutic head-shaking maneuver (HSM). The results were audited immediately after the physical therapy, and at 1 hour. Follow-up by telephonic interviews for 4 weeks was done in all patients. Three out of four patients responded to HSM alone. One patient who did not respond to HSM was successfully treated with four other sequent physical therapies. Conclusion The response of physical therapy for horizontal semicircular cupulolithiasis occasi...

Research paper thumbnail of The Clinical Spectrum of Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo Attending an Otoneurology Center in South Rajasthan, India and Their Response to Appropriate Repositioning Maneuvers at a Short-Term Follow-Up

Annals of Otology and Neurotology

Introduction This article aims to study the clinical spectrum of 20 consecutive patients diagnose... more Introduction This article aims to study the clinical spectrum of 20 consecutive patients diagnosed with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) attending an otoneurology center in Udaipur, Rajasthan, India, over a period of 11 months and their response to appropriate repositioning maneuvers evaluated at short-term follow-up of 1 hour and 24 hours. Study Design This is a nonrandomized prospective interventional study. Materials and Methods Twenty patients with unilateral HSC-BPPV were treated with a session of an appropriate repositioning maneuver (Gufoni maneuver or barbecue roll maneuver for the geotropic variant of HSC-BPPV [geo-HSC-BPPV]; Appiani maneuver or barbecue roll maneuver or head-shaking maneuver for the apogeotropic variant of the HSC-BPPV [apo-HSC-BPPV]). Patients were followed up twice (at 1 hour and 24 hours) and audited by a supine roll test with questioning for the absence or presence of concomitant vertigo. Results At the 1-ho...

Research paper thumbnail of A case of apogeotropic horizontal canal benign paroxysmal positional vertigo that transformed to the geotropic variant during treatment with Appiani maneuver, followed by successful treatment with Gufoni maneuver

Physiotherapy Theory and Practice

Research paper thumbnail of Lack of Torsion in the Type-III Duane Retraction Syndrome (DRS-III) Affected Left Eye During Dix -Hallpike Test

Annals of Otology and Neurotology

Background Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder (CCDD)... more Background Duane retraction syndrome (DRS) is a congenital cranial dysinnervation disorder (CCDD) of ocular movements, characterized by deficits in horizontal duction associated with narrowing of palpebral fissure, retraction of eye globe on attempted adduction and occasionally accompanied by upshoot or downshoot of the eye globe. It is caused by congenital absence of sixth cranial nerve, which results in fibrotic changes in the extraocular muscles leading to an abnormal ocular motility--a concept known as CCDD. Depending on whether only abduction/adduction or both are affected, DRS has been classified into three types designated as type-I, type-II and type-III. The torsional movements of the affected eye in DRS have not been reported to be deficient hitherto, which could be due to difficulties in the routine bedside evaluation of such movements. Case Presentation An unusual case of a patient of left unilateral type-III DRS is reported, who presented with a short history of vertigo ...

Research paper thumbnail of A Case of Right Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo with to-and-fro Canal Switch to Right Horizontal Semicircular Canal

Annals of Otology and Neurotology

Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositionin... more Background Canal switch in BPPV is a phenomenon occurring after therapeutic canalith repositioning maneuvers (CRM), when there is a reflux of the repositioned otoconial debris from utricle to semicircular canal other than the one originally affected. It may be of immediate-type occurring within minutes after CRM or a delayed-type occurring after 2-3 days. Aim The study is a case report. Case Report A 59-year-old female presented with history of severe rotational vertigo as she got up from the bed in the early morning at 5.00 a.m.. Dix-Hallpike test (DHT) on the right elicited an upbeating positional nystagmus (PN). Treatment with multiple consecutive modified right Epley maneuvers (r-MEM) in one session was undertaken. During these maneuvers she continued to have an upbeating PN during the 45-degrees right cervical rotation with the neck in 20-degrees of extension (which is equivalent to right Dix-Hallpike positioning) of the first three sequential r-MEM’s. With the neck maintained ...

Research paper thumbnail of Unveiling Positioning Nystagmus in Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo by Diagnostic Head-Shaking in the Yaw Plane

Annals of Otology and Neurotology

Background The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on e... more Background The diagnosis of benign paroxysmal positional vertigo (BPPV) is largely dependent on elicitation of positioning nystagmus on the diagnostic positional tests, namely Dix-Hallpike and supine roll tests (DHT and SRT, respectively), in patients complaining of vertigo, which occurs when patient's head moves relative to the gravity. The pattern of elicited positioning nystagmus localizes as well as lateralizes the diseased canal, and the therapeutic positioning maneuver is accordingly undertaken. Aim The diagnostic positional tests, at times fail to elicit positional nystagmus, leaving clinician in a state of dilemma, when examining a patient who is currently experiencing paroxysms of vertigo triggered by positional change. In two patients with history consistent with BPPV but with negative positional tests initially, head shaking for 10 seconds in the yaw axis was done, and Dix-Hallpike and supine roll tests were repeated. The aim of head shaking for 10 seconds was to unve...

Research paper thumbnail of Kawasaki disease—Indian perspective

The Indian Journal of Pediatrics, 2001

Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is... more Kawasaki disease is a syndrome of unknown etiology affecting children below 5 years of age and is a leading cause of acquired heart disease in many developed countries. Incidence of this disease in India is extremely low as evidenced by the meagre case reports. Complications due to this disease in Indian patients are still rarer. Here we report two cases of Kawasaki disease both of whom had a benign course. A comparison of this disease in Indian and Western literature shows that the incidence of cardiac complications in the Indian patients is about 10% while in the west it is reported at around 30%. This paucity of complications in the Indian patients may be the reason of poor reporting of this disease in our country.

Research paper thumbnail of A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

Annals of Otology and Neurotology

In any patient with a history of rotational vertigo triggered by changes in the position of head ... more In any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnos...

Research paper thumbnail of A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

Annals of Otology and Neurotology

In any patient with a history of rotational vertigo triggered by changes in the position of head ... more In any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnos...

Research paper thumbnail of Case report: Congenital absence of the dens

Indian Journal of Radiology and Imaging, 2010

A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MR... more A 36-year-old man presented with headache and right upper and lower limb weakness for 10 days. MRI revealed absence of the odontoid process of the C2 vertebral body, with resultant atlantoaxial dislocation along with myelomalacic changes involving the cervicomedullary junction.