Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal positional vertigo

Lopez-Escamez, José A.; Molina, Maria I.; Gámiz, Maria J.; Fernandez-Perez, Antonio; Gómez, Manuel J. Ramos; Palma, María Jesús Castillo; Zapata, Cristóbal

doi:10.1080/00016480510040146

Cited by 82 publications

(66 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Of note, purely vertical downbeating nystagmus has been described with the straight back head hanging position in patients with anterior semicircular canal (AC) BPPV, 7,8 and in one patient with combined AC and PC BPPV. 7 The apparent lack of torsional component of the nystagmus in these patients has been suggested to be due either to a small torsional component that was not clinically detected or a small lesion of the nodulus.…”

Section: Discussionmentioning

confidence: 99%

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Beyea

Parnes

2009

The Laryngoscope

View full text Add to dashboard Cite

Vertical nystagmus occurs in patients with central vestibular system pathology. Lesions of the pons, medulla, and cerebellum lead to vertical nystagmus. Given this association, vertical nystagmus is considered pathognomonic in nature. We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix-Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back head hanging position. Computed tomography imaging of the typically pathologic structures in vertical nystagmus (brainstem/posterior fossa) revealed normal anatomy. We propose this case as an instance of peripheral-associated purely vertical nystagmus without central pathology, while building on our previous understanding of BPPV physiology.

show abstract

Section: Discussionmentioning

confidence: 99%

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Beyea

Parnes

2009

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…An incidence of up to 10% of bilateral posterior canal BPPV among BPPV cases has been reported in several studies [2][3][4][5][6][7][8]. Thus if the Dix-Hallpike test should not be repeated with the opposite side when the test on initial side is positive, potential cases with bilateral posterior canal BPPV would not be diagnosed and treated appropriately.…”

mentioning

confidence: 99%

“…Multicanal BPPV may also simultaneously involve in the posterior and lateral canals, either on the same side or on 2 sides, with a reported incidence of up to 13% among BPPV cases [4][5][6][7][8]. Thus if the supine roll test to evaluate lateral canal BPPV should not be performed since the patient presents with a history corresponding BPPV and shows a positive DixHallpike test, potential cases with multicanal BPPV involving the posterior and lateral canals would not be diagnosed and treated appropriately.…”

mentioning

confidence: 99%

Comments on an Update of Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

Shan¹,

Wang²,

Wang³

2017

Otolaryngol

View full text Add to dashboard Cite

The clinical practice guideline for benign paroxysmal positional vertigo (BPPV) is newly updated by the American Academy of Otolaryngology-Head and Neck Surgery Foundation. The guideline will guide clinicians to manage BPPV in their clinical practice. But some descriptions in the Statement 1a and Statement 1b of the guideline seem not quite clear or appropriate, which would make clinicians have some misunderstandings. Thus we present our opinions: 1) the Dix-Hallpike test should be repeated on the opposite side no matter the test on initial side is negative or positive due to possible presence of bilateral posterior canal BPPV; and 2) no matter the bilateral DixHallpike tests are negative or positive, the supine roll test should be followed due to possible presence of multicanal BPPV variation with involvement of posterior and lateral canals.

show abstract

“…Posterior semicircular canal (PSC) BPPV is the most common clinical variant; however, BPPV of the lateral (LSC) and the anterior (ASC) canals are less commonly observed. Further, BPPV may be bilateral, and it may affect different canals simultaneously [2][3][4] . It is generally accepted that cupulolithiasis, canalithiasis, or both are related to the cause of BPPV: canalithiasis is its most common form [3,5] .…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study Using Intratympanic Methylprednisolone for Treatment of Persistent Posterior Canal Benign Paroxysmal Positional Vertigo

Pérez¹,

Franco²,

Oliva³

et al. 2016

Int Adv Otol

View full text Add to dashboard Cite

OBJECTIVE:To assess the effect of intratympanic methylprednisolone (ITMP) in posterior canal benign paroxysmal positional vertigo (BPPV) that fails treatment involving repositioning maneuver in a case series. MATERIALS and METHODS:Nine patients with persistent posterior canal BPPV after 6 or more repositioning maneuvers were treated by ITMP (two weekly doses of 0.3-0.4 mL at 40 mg/mL) before repeating the repositioning procedures. RESULTS:Following ITMP treatment, 7 out of 9 patients were relieved of their symptoms and did not exhibit positional nystagmus after 1 or 2 repositioning maneuvers. The number of positional maneuvers performed before and after ITMP treatment in these 7 patients showed a statistically significant (p=0.016) reduction in the amount of repositioning treatments required. None of the 7 respondent patients showed any relapses during the follow-up period (follow-up range: 11-95 months). CONCLUSION:Administering ITMP before resuming repositioning procedures can be a useful treatment for persistent BPPV of the posterior canal. Intratympanic (IT) steroids are often used to treat inner ear disorders such as sudden idiopathic sensorineural hearing loss, autoimmune hearing loss, and Ménière's disease [14] . Corticosteroids exert their effects in the inner ear after interacting with intracellular glucocorticoid receptors by producing metabolic and anti-inflammatory effects. It is also known that glucocorticoid receptors are widespread throughout the inner ear, including semicircular canal duct epithelial cells, where they facilitate cation absorption via sodium channels [15][16][17] . KEYWORDS:Thus, considering the possibility of an inflammatory process of the labyrinth or an imbalance of Na + and Ca 2+ in the endolymph could be related with the intractability of BPPV, we have carried out a pilot study to assess the effect of IT methylprednisolone (ITMP) in persistent posterior canal BPPV. MATERIALS and METHODSThis prospective study included patients from 3 different hospitals. From January 2006 to March 2014, we diagnosed 187 patients affected from unilateral posterior canal BPPV. None of them had any symptoms or signs of central nervous system (CNS) disease. A complete otoneurological examination, including otoscopy, audiometry, head thrust test, spontaneous nystagmus recording, gaze-evoked nystagmus test, cover test, and Romberg and Fukuda tests, were performed in all the cases.The diagnosis of posterior canal BPPV was made by Dix-Hallpike test, showing a mixed vertical and torsional nystagmus beating toward the undermost ear, with appropriate latency and duration, and the direction of the nystagmus reversed on resuming the upright position. In every patient, the roll test and head hyperextension test were also performed in order to rule out lateral or superior canal BPPV.Patients with BPPV were treated by Epley or Semont maneuvers. We carried out only one of those maneuvers in every session. Each session, weekly programmed, began with a Dix-Hallpike test; if it was positive for the same posterior...

show abstract

Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal positional vertigo

Cited by 82 publications

References 21 publications

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Purely vertical upbeat nystagmus in bilateral posterior canal benign paroxysmal positional vertigo: A case report

Comments on an Update of Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo

A Pilot Study Using Intratympanic Methylprednisolone for Treatment of Persistent Posterior Canal Benign Paroxysmal Positional Vertigo

Contact Info

Product

Resources

About