Spontaneous nystagmus in benign paroxysmal positional vertigo (original) (raw)
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Otology & Neurotology, 2014
Objectives: To determine the characteristics and diagnostic value of pseudo-spontaneous and head-shaking nystagmus (HSN) in benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). Study Design: Retrospective case series review. Methods: After excluding 19 patients with canal paresis, abnormal head impulse test, recent history of peripheral or central vestibular disorders, or poor cooperation, we retrospectively recruited 127 patients with HC-BPPV from January 2009 to July 2012. The patients included 69 geotropic and 58 apogeotropic types. We analyzed the pattern of pseudo-spontaneous nystagmus and HSN according to the lesion side. Results: Pseudo-spontaneous nystagmus was observed in 87 (87/127, 68.5%) patients, both in geotropic (46/69, 66.7%) and apogeotropic (41/58, 70.7%) types without difference in the prevalence between the types (p = 0.627). Pseudo-spontaneous nystagmus beat more to the lesion side in apogeotropic type (28/41, 68.3%, p = 0.028) but in either direction without directional preponderance in geotropic type (p = 0.659). Of the 90 patients who underwent horizontal head-shaking, 27 (30.0%) showed HSN that was more common in apogeotropic than in geotropic type (22/44 [50.0%] versus 5/46 [10.9%], p G 0.001). Patients with apogeotropic HC-BPPV showed predominantly contralesional HSN (19/22 [86.4%], p = 0.001), whereas patients with geotropic type did not show any directional preponderance of HSN (contralesional in 2 and ipsilesional in 3). Conclusion: HSN is more common and mostly contralesional in apogeotropic HC-BPPV. HSN may be a lateralizing sign in apogeotropic HC-BPPV. Different prevalence and patterns of HSN in apogeotropic and geotropic HC-BPPV suggest dissimilar cupular dynamics in those disorders.
American Journal of Otolaryngology, 2006
Purpose: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). Materials and methods: Study Design. This is a prospective case series. Setting. The study was set at an outpatient clinic in a general hospital. Patients. Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the videooculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. Intervention. Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. Main Outcome Measures. The main outcome measure is the number of patients without pDBN at 30 and 180 days. Results: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. Conclusions: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation. D
Journal of vestibular research : equilibrium & orientation, 2014
To investigate the incidence of Lateral Semicircular Canal BPPV (LSC BPPV) with Pseudo-Spontaneous Nystagmus in patients preliminarily diagnosed for vestibular neuritis in the Emergency Department (ED). Retrospective study of 273 patients with acute vertigo and persistent horizontal nystagmus in upright position (male 110, female 163, 14-93 years old) observed over four years. All the patients were checked for any nystagmus modification by performing the Head Pitch Test (HPT) in the upright position. The HPT modified the beating direction of the persistent horizontal nystagmus in 56 of the 273 examined patients. The positioning tests subsequently confirmed the diagnosis of LSC BPPV in all those 56 patients. There were 37 geotropic variants and 19 apogeotropic variants and all of them were successfully treated by performing liberatory manoeuvres in the course of the same session. Performing the HPT in the upright position helps to differentiate a direction fixed nystagmus from a dire...
Approach to bilateral benign paroxysmal positioning vertigo
American Journal of Otolaryngology, 2006
Background: Bilateral benign paroxysmal positioning vertigo (bBPPV) is rather rare, accounting for up to 10% in the reported benign paroxysmal positioning vertigo (BPPV) series. Inappropriate head positioning during testing in unilateral BPPV causes the otolith debris in the uppermost ear to move toward the cupula, resulting in an inhibitory nystagmus and mimicking bBPPV. Purpose: We analyzed the clinical data of patients with bilaterally positive Dix-Hallpike maneuver and compared them with the characteristics of patients with unilateral BPPV. We further tried to propose a simple schematic approach to the treatment of patients with bilaterally positive Dix-Hallpike maneuver. Materials and methods: Medical records of 232 patients treated for BPPV at our dizziness clinic during 1999 to 2003 were reviewed. An algorithm used for the treatment of patients with bilaterally positive BPPV is discussed. Results: Twenty-eight patients with bilaterally positive Dix-Hallpike test were found. Sixteen were diagnosed with bBPPV, and 12 were diagnosed with unilateral mimicking bBPPV. Thirty patients with unilateral posterior canal BPPV served as control subjects.No difference in age, sex distribution, duration of symptoms, number of treatments per ear, and recurrence was found between bBPPV and unilateral BPPV. The female sex appeared to be predisposed for more treatments. The total duration of BPPV symptoms obtained by history was found to correlate with the number of recurrences after treatment. Conclusions: We conclude that bBPPV can be readily distinguished from unilateral mimicking bBPPV. Patients with bBPPV do not differ from patients with unilateral BPPV in clinical characteristics. The mechanism of otolith debris dislodgment appears to be the main cause of bilaterality, trauma being a more common trigger than other known causes of BPPV.
The Gold Standard Diagnosis for Benign Paroxysmal Positional Vertigo
Romanian Journal of Neurology, 2012
Objectives. The purpose of this paper is to improve quality of care for posterior canal BPPV patients by making an accurate and efficient diagnosis and by decreasing the inappropriate use of expensive tests such as radiographic imaging and vestibular testing. Method and materials. The study was conducted in our clinic on a group of 82 BPPV patients over an eleven months time frame between January 2011 and November 2011. The Dix-Hallpike maneuver was applied to each patient. Results were statistically analyzed with the program Microsoft Excel 2003. Results. Out of the 82 patients 90% were diagnosed with posterior canal BPPV by performing the Dix-Hallpike maneuver, another 9% of the patients had horizontal canal BPPV and only 1% had superior canal BPPV. 76 patients were found in stable condition at the follow-up control one week after the repositioning maneuvers. This demonstrates a 92,6% rate of success of this treatment following a correct diagnosis. Conclusions. The Dix-Hallpike ma...