Clinical and VNG Features in Anterior Canal BPPV—An Analysis of 13 Cases

Abstract

Objective: To define diagnostic VNG features in anterior canal BPPV during positional testing (Dix-Hallpike, supine head hanging, and McClure Pagnini tests).Study Design: A retrospective study of patients diagnosed with anterior canal BPPV across four referral centers in New Delhi, Kochi, Bangalore, and Dubai.Subjects and Methods: Clinical records of 13 patients with AC BPPV out of 1,350 cases, during a 3-years period, were reviewed and analyzed by four specialists.Results: Four patients had positional down beating nystagmus with symptoms of vertigo during the bilateral DHP maneuver. Seven cases had positional down beating nystagmus only on one side of DHP. Typical down beating nystagmus was seen in 10 out of 13 cases during the straight head hanging maneuver. Down beating torsional nystagmus was seen in 6 out of 13 cases. Down beating with horizontal nystagmus was seen in three cases (in DHP and MCP mainly) while pure down beating nystagmus during SHH was only seen in four cases.Conclusion: We conclude that anterior canal BPPV is a rare but definite entity. It may not be apparent on positional testing the first time, so repeated testing may be needed. The most consistent diagnostic maneuver is SHH though there were patients in which findings could only be elicited using DHP testing. We recommend a testing protocol that includes DHP testing on both sides and SHH. MCP testing may also evoke DBN with or without the torsional component. Reversal of nystagmus on reversal of testing position is unusual but can occur. The Yacovino maneuver is effective in resolving AC BPPV. We also propose a hypothesis that explains why DHP testing is sensitive to AC BPPV on either side, whereas MCP lateral position on one side is only sensitive to AC BPPV on one side. We have explained a possible role for the McClure Pagnini test in side determination and therapeutic implications.

Benign paroxysmal positional vertigo: A practical approach for emergency physicians

“…One clue suggesting hc-BPPV is that on Dix-Hallpike testing, the patient has definite symptoms but the Therefore, if the downbeating nystagmus is persistent (continues as long as the patient is in the position) or does not respond to positional treatment, then it is safest to consult neurology and/or perform magnetic resonance imaging (MRI) in suspected BPPV patients with downbeating nystagmus. 49,50 Wrong "PPV"…”

Author Response: Re: Benign Paroxysmal Positional Vertigo: Canal Switching Affecting All Canals During a Single Session

“…In the first two Dix-Hallpike (DH) maneuvers the torsional component was consistently to the right (affected) side regardless of the vertical component. As discussed in the video report (1), the spatial orientation of both superior canals (about 108 closer to the sagittal plane than the PC) increases the likelihood that SC-BPPV could be equally provoked in both the DH maneuver and the Head Hanging maneuver (2)(3)(4), again in the left SC BPPV the torsional component could be absent or beat to the left side instead of to the right. In right aPC BPPV the torsional component should beat to the left (rather than right), as in this case.…”

Application of a pupil tracking method based on Yolov5-Deeplabv3+ fusion network on a new BPPV nystagmus recorder

“…Studies have shown that nystagmus, an involuntary, rapid, and rhythmic movement of the eyeball, has a close coupling relationship with BPPV [2,3]. Therefore, the analysis of abnormal eye movement information is of great significance in diagnosing BPPV.…”