Pseudo-spontaneous nystagmus in patients with geotropic direction-changing positional nystagmus

Hong, Seok Min; Kim, Sung Kyun; Park, Il-Seok; Shim, Min Gyeong

doi:10.1371/journal.pone.0196019

Cited by 9 publications

(9 citation statements)

References 11 publications

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“…Kim et al 40 reported that PSN was present in 100% of patients with a light cupula, while another study did not find PSN in some patients with a light cupula when they were sitting with the head upright. Hong et al 41 observed PSN more often in patients with pG-DCPN than in patients with transient DCPN, and the direction of PSN was toward the unaffected side. When the head is erect, an angle of 30° between the lateral semicircular canal and horizontal plane can place the ampulla in a higher position than the other semicircular canals, which causes the light cupula to deviate toward the utricle, leading to PSN.…”

Section: Discussionmentioning

confidence: 97%

“…Previous morphological studies of squirrel monkeys and computed tomography of human inner ear revealed that the top of the cupula of the HC faces outward, and it is speculated that the cupula of the HC is at an angle of approximately 20° to the median sagittal plane. 41 Turning the patient's head toward the affected side at a certain angle will result in the long axis of the affected cupula being parallel to the axis of gravity, which does not cause deflection of the cupula, and produces no nystagmus; this is when the null plane is observed, and the side of the null plane is consistent with the affected side. 14 In our study, 88.6% of the patients with pAG-DCPN and 93.3% of the patients with pG-DCPN had the second NP.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

Shen

et al. 2021

J Clin Neurol

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Background and Purpose This study aimed to determine the clinical features, diagnosis, and treatment of patients with persistent geotropic (pG) and persistent apogeotropic (pAG) direction-changing positional nystagmus (DCPN). Methods This retrospective study included 30 patients with pG-DCPN and 44 patients with pAG-DCPN. All patients underwent neurological and neurotological examinations, including an evaluation of gaze-evoked nystagmus, eye-movement tests, and assessments of limb ataxia and balance, as well as magnetic resonance imaging to exclude central causes. The characteristics of positional nystagmus were detected using the supine roll test (SRT) and bow-and-lean test (BLT). The null point (NP) at which the nystagmus disappeared was determined. All patients were treated with the barbecue maneuver, and treatment efficacy was evaluated immediately, 1 week, and 1 month after treatment. Results The history of diseases associated with atherosclerosis, peripheral vestibular disorders, otological disease, and migraine differed significantly between patients with pG-DCPN and pAG-DCPN. The affected sides of persistent horizontal DCPN can be determined using the SRT and the BLT, while determining the second NP and vestibular function as well as performing an audiological evaluation can be used to assist in identifying the affected side. The efficacy rates immediately and 1 week after treatment with the barbecue maneuver were higher in patients with pAG-DCPN than in patients with pG-DCPN. Conclusions pAG-DCPN was more compatible with the characteristics of cupulolithiasis, and pG-DCPN was more likely to be associated with a light cupula rather than canalolithiasis. pAG-DCPN was more likely to be accompanied by a disease associated with atherosclerosis, while pG-DCPN was often accompanied by autoimmune-related diseases and a history of migraine. The associations between pAG-DCPN, pG-DCPN, and the above-mentioned diseases need to be clarified further. The canalith-repositioning maneuver was effective in patients with pAG-DCPN and ineffective in patients with pG-DCPN, but most cases of pG-DCPN are self-limiting.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

Shen

et al. 2021

J Clin Neurol

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“…Previous studies have reported that the clinical data and resolution time differed between persistent and transient geotropic DCPN and suggested the mechanisms differed [6,8,12]. In one study, the conventional repositioning maneuver used to treat geotropic DCPN (HSCC-BPPV) was ineffective for patients with persistent geotropic DCPN [13].…”

Section: Discussionmentioning

confidence: 99%

Differences in the Head Roll Test, Bow and Lean Test, and Null Plane between Persistent and Transient Geotropic Direction-Changing Positional Nystagmus

Kim

Hong

2019

JCM

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Background: Persistent geotropic direction-changing positional nystagmus (DCPN) has the characteristics of cupulopathy, but its underlying pathogenesis is not known. We investigated the relationship of the results of the head roll test, bow and lean test, and side of the null plane between persistent and transient geotropic DCPN to determine the lesion side of persistent geotropic DCPN and understand its mechanism. Methods: We enrolled 25 patients with persistent geotropic DCPN and 41 with transient geotropic DCPN. We compared the results of the head roll test, bow and lean test, and side of the null plane between the two groups. Results: The rates of bowing and leaning nystagmus were significantly higher in the persistent DCPN group. Only 16.0% of the persistent DCPN patients had stronger nystagmus in the head roll test and the null plane on the same side. The rates of the direction of bowing nystagmus in the bow and lean test and stronger nystagmus in the head roll test on the same side were also significantly lower in persistent DCPN than in transient DCPN. Conclusion: It was difficult to determine the lesion side in persistent geotropic DCPN using the direction of stronger nystagmus in the head roll test and null plane when the direction of the stronger nystagmus and null plane were opposite. Further study is needed to understand the position of the cupula according to head rotation and the anatomical position in persistent geotropic DCPN.

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“…Several recent studies have reported the occurrence of spontaneous nystagmus in the sitting position in patients with BPPV [7][8][9][10]. Such nystagmus is direction changing in nature, modulated by head position in the pitch plane.…”

Section: Introductionmentioning

confidence: 99%

Pseudo-spontaneous nystagmus in lateral semicircular canal benign paroxysmal positional vertigo: Correlation with bow and lean test in a pitch plane

et al. 2020

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Objectives We investigated the incidence and characteristics of pseudo-spontaneous nystagmus (PSN) in benign paroxysmal positional vertigo involving the lateral semicircular canal (LC-BPPV) and evaluated the correlation between PSN and the bow and lean test. Methods We examined nystagmus in the sitting position using video-oculography goggles in 131 LC-BPPV patients. The positioning test and bow and lean test were also performed. Patients were divided into canalolithiasis and cupulolithiasis groups according to the character of nystagmus. In each group, the incidence and direction of PSN, correlation with the bow and lean test, and treatment outcome were analyzed. Results PSN was observed in 25 cases (19.1%) in LC-BPPV patients, 7 of which were canalolithiasis and 18 of which were cupulolithiasis (p = 0.098). Of the 25 patients with PSN, 21 (84%) exhibited nystagmus consistent with the lean test whereas 4 (16%) exhibited nystagmus consistent with the bow test. In patients with PSN, nystagmus was observed in the bow and lean test in all cases (23/23), but in patients without PSN, no nystagmus was observed in 13 cases (13/87) in the bow and lean test (p = 0.048). The number of barbecue maneuvers performed until the end of treatment was 1.4 ± 0.7 in patients with PSN and 1.4 ± 0.9 in those without PSN (p = 0.976). Conclusion We identified PSN in patients with LC-BPPV irrelevant of subtype. Moreover, all patients with PSN showed nystagmus in the bow and lean test. The direction of PSN was mostly consistent with that of the lean test (21/25, 84%). The presence of PSN was not related to the treatment outcome in this study.

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Pseudo-spontaneous nystagmus in patients with geotropic direction-changing positional nystagmus

Cited by 9 publications

References 11 publications

Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

Clinical Characteristics of Patients with Persistent Apogeotropic and Persistent Geotropic Direction-Changing Positional Nystagmus

Differences in the Head Roll Test, Bow and Lean Test, and Null Plane between Persistent and Transient Geotropic Direction-Changing Positional Nystagmus

Pseudo-spontaneous nystagmus in lateral semicircular canal benign paroxysmal positional vertigo: Correlation with bow and lean test in a pitch plane

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