Diagnostic Criteria for Central versus Peripheral Positioning Nystagmus and Vertigo: a Review

Büttner, U.; Helmchen, C.; Brandt, Th.

doi:10.1080/00016489950181855

Cited by 174 publications

(41 citation statements)

References 14 publications

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“…While it is proposed that a central origin has to be assumed for pure upbeat, downbeat, and torsional nystagmus (1), we found that in about a one-third of cases (29.9%), CPN was a mixture of horizontal, torsional, and vertical components in variable combinations depending on the positioning maneuver performed. Furthermore, the direction of CPN is not always “atypical” for the plane of the canal being stimulated, since downbeat nystagmus was the most prominent direction during SHH (in 77.3%) while pHN was most prominent upon supine head turning (in 80.5%).…”

Section: Discussioncontrasting

confidence: 53%

“…Maire and Duvoisin (11) found that, in a sample of 43 patients with static PN, the predictive value of the ocular fixation test was 94% ( n = 35) for peripheral lesions and a 100% ( n = 8) for central disorders, with the latter being associated with reduced optic fixation index. Buttner et al (1, 6) reported poor vestibular ocular reflex (VOR) suppression (6), while Williams et al (25) reported normal VOR suppression (25). Furthermore, Barber (14) reported pDBN, which was indeed enhanced with fixation, and Cobb and Friedman (18) reported nystagmus, which disappeared when fixation was removed.…”

Section: Resultsmentioning

confidence: 99%

“…Currently, it is based on the presence of deviations to the diagnostic criteria for benign paroxysmal positional vertigo (BPPV) (1), and the clinical profile has otherwise received little attention. Atypical or infrequent variants of BPPV (2), interchangeable use of terminology, and absence of widely accepted definitions for central positional syndromes all add to the diagnostic challenges.…”

Section: Introductionmentioning

confidence: 99%

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Central Positional Nystagmus: A Systematic Literature Review

Macdonald

Kaski²,

Saman

et al. 2017

Front. Neurol.

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ObjectiveTo provide a systematic review of the clinical and radiological features of lesion-induced central positional nystagmus (CPN) and identify salient characteristics that differentiate central from peripheral positional nystagmus (PN).MethodsSystematic literature search according to the preferred reporting items for systematic reviews and meta-analysis.ResultsA total of 82 patients from 28 studies met the participants intervention, comparison, outcomes, and study designs criteria for inclusion. An atypical direction of nystagmus for the stimulated canal was reported in 97.5% patients during Dix–Hallpike (D–H) and 54.5% upon supine roll testing. Five types of CPNs were identified during positional testing: positional horizontal nystagmus (pHN) (36.8%), positional downbeating nystagmus (pDBN) (29.2%), positional torsional nystagmus (pTN) (2.1%), positional upbeating nystagmus (pUBN) (2.1%), and a combination of the four profiles (29.9%). CPN was paroxysmal (<60 s) in 85% patients on straight head hanging (SHH), 63.9% on D–H, and 37.5% on supine roll, and had a latency <3 s upon positioning in 94.7% patients in which it was reported. Concurrent vertigo was reportedly present in 63.4% patients and 48.8% demonstrated other neurological signs. Radiologically, in 74.4%, there was mention of cerebellar involvement, isolated brainstem involvement in 8.5%, and 14.6% involved the fourth ventricle.ConclusionCurrently, there is a lack of robust data on the clinical and radiological characteristics of CPN highlighting the need for better phenotyping of CPN to help differentiate this entity from peripheral causes of PN. With increased awareness of CPN, particularly in the acute setting, we may see a change in the estimated prevalence of CPN and improved clinical markers to promptly identify the frequently sinister underlying causes.

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Section: Discussioncontrasting

confidence: 53%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Central Positional Nystagmus: A Systematic Literature Review

Macdonald

Kaski²,

Saman

et al. 2017

Front. Neurol.

View full text Add to dashboard Cite

show abstract

“…Maire and Duvoisin (11) found that, in a sample of 43 patients with static PN, the predictive value of the ocular fixation test was 94% (n = 35) for peripheral lesions and a 100% (n = 8) for central disorders, with the latter being associated with reduced optic fixation index. Buttner et al (1,6) reported poor vestibular ocular reflex (VOR) suppression (6), while Williams et al (25) reported normal VOR suppression (25). Furthermore, Barber (14) reported pDBN, which was indeed enhanced with fixation, and Cobb and Friedman (18) reported nystagmus, which disappeared when fixation was removed.…”

Section: Fixationmentioning

confidence: 95%

Central Positional Nystagmus: A Systematic Literature Review

Kaski

Macdonald

Saman³

et al. 2016

J Neurol Neurosurg Psychiatry

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Objective: To provide a systematic review of the clinical and radiological features of lesion-induced central positional nystagmus (CPN) and identify salient characteristics that differentiate central from peripheral positional nystagmus (PN).Methods: Systematic literature search according to the preferred reporting items for systematic reviews and meta-analysis.Results: A total of 82 patients from 28 studies met the participants intervention, comparison, outcomes, and study designs criteria for inclusion. An atypical direction of nystagmus for the stimulated canal was reported in 97.5% patients during Dix-Hallpike (D-H) and 54.5% upon supine roll testing. Five types of CPNs were identified during positional testing: positional horizontal nystagmus (pHN) (36.8%), positional downbeating nystagmus (pDBN) (29.2%), positional torsional nystagmus (pTN) (2.1%), positional upbeating nystagmus (pUBN) (2.1%), and a combination of the four profiles (29.9%). CPN was paroxysmal (<60 s) in 85% patients on straight head hanging (SHH), 63.9% on D-H, and 37.5% on supine roll, and had a latency <3 s upon positioning in 94.7% patients in which it was reported. Concurrent vertigo was reportedly present in 63.4% patients and 48.8% demonstrated other neurological signs. Radiologically, in 74.4%, there was mention of cerebellar involvement, isolated brainstem involvement in 8.5%, and 14.6% involved the fourth ventricle. Conclusion:Currently, there is a lack of robust data on the clinical and radiological characteristics of CPN highlighting the need for better phenotyping of CPN to help differentiate this entity from peripheral causes of PN. With increased awareness of CPN, particularly in the acute setting, we may see a change in the estimated prevalence of CPN and improved clinical markers to promptly identify the frequently sinister underlying causes.

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“…Dangerous causes include neurologic mimics known as ‘central paroxysmal, positional vertigo’ (CPPV) (e.g., posterior fossa mass lesions 34 ) and serious causes of orthostatic hypotension, 35 such as internal bleeding. All are associated with episodic positional symptoms, but can be readily distinguished from one another using targeted bedside history and exam.…”

Section: Four Vestibular Syndromesmentioning

confidence: 99%

TiTrATE

2015

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Diagnosing dizziness can be challenging, and the consequences of missing dangerous causes such as stroke can be substantial. Most physicians use a diagnostic paradigm developed over 40 years ago that focuses on the type of dizziness (e.g., vertigo vs. non-vertigo), but this approach is flawed. In this article we propose a new paradigm based on symptom timing, triggers, and targeted bedside eye examinations (‘TiTrATE’). Using timing and triggers, patients with recent-onset dizziness will fall into one of four major ‘syndrome’ categories (triggered episodic, spontaneous episodic, post-exposure acute, and spontaneous acute), each with its own differential diagnosis and set of targeted examination techniques that help clinicians make a specific diagnosis. Following an evidence-based approach such as this could help reduce the frequency of misdiagnosis of serious causes of dizziness.

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Diagnostic Criteria for Central versus Peripheral Positioning Nystagmus and Vertigo: a Review

Cited by 174 publications

References 14 publications

Central Positional Nystagmus: A Systematic Literature Review

Central Positional Nystagmus: A Systematic Literature Review

Central Positional Nystagmus: A Systematic Literature Review

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