Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

Navarro, Paula Peña; Pacheco-López, Sofía; Ayerve, Cristina Nicole Almeida; Alonso, Susana Marcos; López, José Manuel Serradilla; Ruíz, Santiago Santa Cruz; Sánchez, José Carlos Gómez; Kaski, Diego; Batuecas‐Caletrío, Ángel

doi:10.3390/brainsci13040562

Cited by 3 publications

(4 citation statements)

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“…Certain atypical, and rarer forms of BPPV can present with nystagmus that would be more typical for a central cause (e.g., positional downbeat nystagmus in anterior canal BPPV, or nystagmus that does not fatigue in cupulolithiasis-type posterior canal BPPV). Diagnosing central positional nystagmus remains a clinical challenge due to the overlap in oculomotor characteristics with BPPV and is largely based on atypical features for BPPV rather than its own specific characteristics ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, central positional nystagmus (CPN) is attributed to disease affecting the central nervous system and is an important differential diagnosis to BPPV. CPN has been reported in a range of neurological disorders ( 5 ), including multiple sclerosis ( 6 ), cerebellar disease ( 7 ), and cerebellar stroke ( 8 ), with the commonest central cause being vestibular migraine (VM) particularly during an attack ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of CPN is poorly understood but it is thought be due to an impaired integration of semicircular canals and central vestibular pathways in the cerebellum and brainstem and consequently providing a poor estimation of head tilt and/or eye position coordinates ( 9 ). Features of CPN include: (a) nystagmus that is atypical for BPPV is observed in the positional maneuvers, (b) the nystagmus fails to resolve with treatment, (c) additional neurological or ocular motor symptoms signs may be present ( 5 , 9 ). This highlights the importance of completing positional tests and an oculomotor assessment to differentiate central from peripheral causes ( 2 , 11 , 12 ), preferably with nystagmus documentation using video oculography.…”

Section: Introductionmentioning

confidence: 99%

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Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

Koohi,

Male,

Kaski

2023

Front. Neurol.

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IntroductionBenign paroxysmal positional vertigo (BPPV) is the most common cause of positional vertigo. However, positional vertigo can also be due to diseases affecting the central vestibular pathways, such as vestibular migraine. Accurate and timely diagnosis enables effective triage and management.ObjectivesTo evaluate diagnoses made by emergency clinicians compared to acute vertigo specialists, in patients presenting to an emergency department (ED) with positional vertigo.MethodsFollowing routine ED care, patients with a primary complaint of dizziness, vertigo, light-headedness or unsteadiness, underwent detailed neuro-otological assessment by acute vertigo specialists. Demographics and final diagnoses were recorded and analyzed.ResultsOf 71 consented patients (21−91 years; mean 56 years, ±16.7 years, 40 females), ED identified 13 with a peripheral cause of positional vertigo (mean 48.85 years, ±16.19, 8 females). Central positional nystagmus was not noted in any of the patients with positional vertigo seen by the ED clinicians. Acute vertigo specialists diagnosed nine patients with BPPV (age range 50-88 years, mean 66 years, ±12.22, 5 females), and six with central positional nystagmus (age range 23−59 years, mean 41.67 years, ±15.78, 6 females).ConclusionPositional vertigo should be assessed with positional maneuvers such as Dix-Hallpike and Roll tests in the ED to identify peripheral and central nystagmus features. Central causes are more common in younger females, with the presence of vomiting, and/or a background of motion sensitivity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

Koohi,

Male,

Kaski

2023

Front. Neurol.

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“…2. Recurrent positional vertigo, most often due to BPPV [4]; central positional vertigo is rarely due to a CNS involvement and usually needs to be considered in patients with persistence of positional vertigo or poor response to CRM [5]. 3.…”

Section: Introductionmentioning

confidence: 99%

Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience

Casani,

Gufoni,

Ducci

2023

Audiology Research

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(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019–31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical–instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient’s clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.

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Clinical Practice Update Part II: Considerations for Treatment and Management of Benign Paroxysmal Positional Vertigo

Nogi,

Fischer,

Ludwig

et al. 2023

Curr Treat Options Neurol

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Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

Cited by 3 publications

References 38 publications

Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

Acute positional vertigo in the emergency department—peripheral vs. central positional nystagmus

Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience

Clinical Practice Update Part II: Considerations for Treatment and Management of Benign Paroxysmal Positional Vertigo

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