Unintentional conversion of benign paroxysmal positional vertigo caused by repositioning procedures for canalithiasis: transitional BPPV

Abstract

BPPV when diagnosed before any repositioning procedure is called primary BPPV. Primary BPPV canalithiasis treatment with repositioning procedures sometimes results in unintentional conversion of BPPV form: transitional BPPV. Objectives were to find transitional BPPV forms, how they influence relative rate of canal involvement and how to be treated. This study is a retrospective case review performed at an ambulatory, tertiary referral center. Participants were 189 consecutive BPPV patients. Main outcome measures were detection of transitional BPPV, outcome of repositioning procedures for transitional canalithiasis BPPV and spontaneous recovery for transitional cupulolithiasis BPPV. Canal distribution of primary BPPV was: posterior canal (Pc): 85.7% (162/189), horizontal canal (Hc): 11.6% (22/189), anterior canal (Ac): 2.6% (5/189); taken together with transitional BPPV it was: Pc: 71.3% (164/230), Hc: 26.5% (61/230), Ac: 2.2% (5/230). Transitional BPPV forms were: Hc canalithiasis 58% (24/41), Hc cupulolithiasis 37% (15/41) and common crux reentry 5% (2/41). Treated with barbecue maneuver transitional Hc canalithiasis cases either resolved in 58% (14/24) or transitioned further to transitional Hc cupulolithiasis in 42% (10/24). In follow-up of transitional Hc cupulolithiasis we confirmed spontaneous recovery in 14/15 cases in less than 2 days. The most frequent transitional BPPV form was Hc canalithiasis so it raises importance of barbecue maneuver treatment. Second most frequent was transitional Hc cupulolithiasis which very quickly spontaneously recovers and does not require any intervention. The rarest found transitional BPPV form was common crux reentry which is treated by Canalith repositioning procedure. Transitional BPPV taken together with primary BPPV may decrease relative rate of Pc BPPV, considerably increase relative rate of Hc BPPV and negligibly influence relative rate of Ac BPPV. Transitional BPPV forms can be produced by repositioning maneuvers (transitional Hc cupulolithiasis) or by the subsequent controlling positional test (transitional Hc canalithiasis and common crux reentry); underlying mechanisms are discussed.

Lo switch canalare: possibile complicanza della terapia liberatoria per la VPPB del canale posteriore

“…The authors stated that the immediate reassessment through the DH-T performed less than two minutes after CRP could facilitate the canal switch; a 15-minute delay seemed sufficient to avoid it. Babic et al 19 reported 41/162 cases (25.3%) of either canal switch or canal re-entry: 39 from the posterior canal to the lateral canal, 24 in geotropic form and 15 in apogeotropic form -lateral cupulolithiasis according to the authors’ terminology, and 2 posterior canal re-entries. Switches did not occur during CRP but at the control through DH-T performed less than one minute after CRP.…”

Benign Paroxysmal Positional Vertigo (Bppv): Case Report With Epley Manoeuver

“…Canalithiasis explains the BPPV symptoms and their characteristics (such as short duration and latency and fatigability). Patients whose BPPV is due to this condition have good results with the Epley's treatment, with rehabilitation rates between 87 and 100% [11, [16][17][18][19].…”

Epley and beyond: an update on treating positional vertigo

“…Therefore, it is important to rule out a central aetiology in patients with positional downbeat nystagmus before attributing the nystagmus to anterior canal BPPV, ideally with MRI of the brain. Anterior canal BPPV may also result from particles entering this canal during repositioning manoeuvres for posterior canal BPPV,14 27 which can be treated with several additional manoeuvres (see below).…”