Lying-down nystagmus and head-bending nystagmus in horizontal semicircular canal benign paroxysmal positional vertigo: are they useful for lateralization?
10
Citation
35
Reference
10
Related Paper
Citation Trend
Abstract:
Lateralization of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is very important for successful repositioning. The directions of lying-down nystagmus (LDN) and head-bending nystagmus (HBN) have been used as ancillary findings to identify the affected sites. This retrospective study was performed to evaluate the lateralizing values of LDN and HBN using clinical and laboratory findings for lateralizing probabilities in patients with HSC-BPPV. For 50 HSC-BPPV patients with asymmetric direction-changing horizontal nystagmus (DCHN) during the head-rolling test (HRT) using Frenzel goggles, the directions of LDN and HBN were evaluated and compared to those determined by video-oculography. Directional LDN was defined as the contralesional direction of nystagmus in geotropic types and the ipsilesional direction in apogeotropic types. Directional HBN was defined as the opposite direction relative to directional LDN. We also analyzed LDN and HBN in 14 patients with a history of ipsilesional peripheral vestibulopathy, caloric abnormality or conversion from other types of BPPV (such as probable localized HSC-BPPV, pro-BPPV). LDN and HBN were seen in 68% (34/50) and 76% (38/50) of patients, respectively. Of these, 19 (55.9%), and 28 (73.7%) patients showed directional LDN and HBN, respectively. The proportion of patients with directional LDN and HBN was much smaller among the pro-BPPV patients (4/12 for LDN, 3/10 for HBN). LDN and HBN did not seem to predict lateralization in patients with HSC-BPPV. To improve the prediction of lateralization of HSC-BPPV, it is necessary to modify the maneuvers used to elicit LDN or HBN, especially in cases of symmetric DCHN during HRT.Keywords:
Electrooculography
Posterior Semicircular Canal
To investigate the characteristics of canal conversion between the anterior and posterior semicircular canals in benign paroxysmal positional vertigo (BPPV).Retrospective chart review.Secondary referral center.A total of 709 patients who were treated with the Epley maneuver for BPPV of the anterior or posterior semicircular canal.Vestibular examinations with videonystagmography and the canalith repositioning procedure (CRP) to treat BPPV.Canal conversion between the anterior and posterior semicircular canals was observed in 18 (2.9%) patients who underwent CRP. In 13 (2.3%) of 564 patients initially diagnosed with posterior canal BPPV (PC-BPPV), switch to anterior canal BPPV (AC-BPPV) was observed at a follow-up visit. In 5 (12.1%) of 41 patients who presented with AC-BPPV, canal switch to PC-BPPV occurred more frequently (p = 0.005). The average number of CRPs before nystagmus resolution was 3.6 in conversion cases versus 1.6 in the nonconversion group (p < 0.001).Canal conversion between the anterior and posterior semicircular canals can occur during treatment. The possibility of canal conversions should be considered for appropriate management of BPPV of the vertical semicircular canals.
Posterior Semicircular Canal
Cite
Citations (20)
Objective To analyze clinical characteristics and therapy of benign paroxysmal positional vertigo.Methods Histories of 131 cases of BPPV were inquired and their clinical data retrospectively analyzed.All the patients were followed up for 3 months.Results Of the 131 patients,51 were male and 80 were female,with a mean age of 47.7 years (20 to 82 years).Lesion was located in the posterior semicircular canal in 75 patients,horizontal semicircular canal in 39 patients,horizontal semicircular cup in 4 patients,superior semicircular canal in 1 patient,and combined multiple semicircular canals in 8 patients.Symptoms were subjective in 3 patients.Idiopathic BPPV was diagnosed in 103 patients,and secondary BPPV in the rest patients.Conclusion Patients with BPPV have various clinical characteristics.Understanding of such characteristics is necessary to apply appropriate repositioning maneuvers.
Posterior Semicircular Canal
Cite
Citations (1)
Objective To investigate the diagnosis and treatment of secondary benign paroxysmal positional vertigo(BPPV).Method We reported six cases of secondary posterior semicircular canal benign paroxysmal positional vertigo.The diagnosis w as based on history and nystagmus induced by Dix-Hallpike test.Results Six cases of inner ear disease associated w ith the posterior semicircular canal benign paroxysmal positional vertigo w as diagnosed by DixHallpike test.There w ere three cases of sudden deafness,tw o cases of Meniere's disease and one case of vestibular neuronitis,respectively.Vertical torsional nystagmuses w ere induced in all the patients.Conclusions Secondary benign paroxysmal positional vertigo is rare in clinic,and posterior semicircular canal w as involved mostly.It can be diagnosed and cured by the Dix-Hallpike test and Epley manipulative method.
Posterior Semicircular Canal
Cite
Citations (0)
Cite
Citations (3)
Conclusion. Video-oculography demonstrates a higher occurrence of atypical positional nystagmus in patients with benign paroxysmal positional vertigo (BPPV). This includes anterior and horizontal canal variants and multiple positional nystagmus, suggesting combined lesions affecting several canals. Objective. To analyse the video-oculographic findings of positional tests in patients with BPPV. Material and methods. Seventy individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of positional nystagmus as confirmed by video-oculographic examination during the Dix–Hallpike test, the McClure test or the head-hanging manoeuvre. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal (Epley's manoeuvre for the posterior or anterior canals and Lempert's manoeuvre for the lateral canal) and the effectiveness was evaluated at 7 and 30 days. Results. Twenty-nine individuals (41.43%) presented an affected unilateral posterior canal. Fifteen patients (21.43%) presented a pure horizontal direction-changing positional nystagmus consistent with a diagnosis of horizontal canal BPPV. Twelve individuals (17.14%) presented a unilateral down-beating nystagmus, suggesting possible anterior canal BPPV. In addition, 14 patients (20%) showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV, 5 had bilateral posterior canal BPPV and 2 presented a positional down-beating nystagmus in both left and right Dix–Hallpike manoeuvres and the head-hanging manoeuvre, which is highly suggestive of anterior canal BPPV. However, seven individuals showed positional horizontal and vertical side-changing nystagmus that could not be explained by single-canal BPPV. These patients with multiple positional nystagmus showed changing patterns of positional nystagmus at follow-up.
Posterior Semicircular Canal
Cite
Citations (86)
Objective To study whether there will be a reduction on the falls of elderly patients with BPPV after the particle repositioning maneuver( PRM). Methods The elderly above 60 with BPPV who had falls during the past 5 year was studied retrospectively. All patients accepted the PRM according to the affected semicircular canal. After positioning vertigo and nystagmus subsidised,the patients accepted a 12 month follow-up and were investigated about the number of falls. Wilcoxon's test was performed to compare the number of falls before and after 12 months of the PRM. Results One hundred and forty seven patients were included in the study. One hundred and twenty one patients involved the posterior semicircular canal,18 of the lateral and 8 of the anterior. The Epley maneuver was used for posterior semicircular canal and superior semicircular canal BPPV,and the Lempert maneuver was used for lateral semicircular canal BPPV. We noticed a reduction on the number of falls,with statistically significant difference when all the patients were analyzed together( P 0. 01),the posterior canal BPPV patients( P 0. 01),the lateral canal BPPV patients( P = 0. 001) and the anterior canal BPPV patients( P = 0. 016). Conclusion The PRM could reduce the number of falls of elderly patients with BPPV.
Posterior Semicircular Canal
Cite
Citations (0)
Benign paroxysmal positional vertigo of the superior semicircular canal is a rare form of BPPV. It accounts for 1% to 3% of cases. The characteristic nystagmus is positional, down-beating, with a torsional component elicited by the Dix-Hallpike maneuver. Symptoms of superior semicircular canal BPPV often resolve spontaneously; however, it can be refractory to repositioning maneuvers. Surgical management is described for posterior semicircular canal BPPV. To date, however, there is only one reported case of surgical management for superior semicircular canal BPPV. Here we show video documentation of positional, down-beating nystagmus and describe a case of superior semicircular canal BPPV requiring canal occlusion with successful resolution of symptoms.
Posterior Semicircular Canal
Cite
Citations (11)
Conclusion: To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV.Objective: Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver.Materials and methods: This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model.Results: The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.
Posterior Semicircular Canal
Supine position
Cite
Citations (5)
Posterior Semicircular Canal
Vestibular disorders
Vestibule
Cite
Citations (11)
Objective:To explore treatment and therapeutic effectiveness of patients with Meniere' s disease and benign paroxysmal positional vertigo.Method: A series of BPPV 60 cases was retrospective analyzed. The patients were divided into three groups: Meniere' s disease with multiple semicircular canal BPPV(n=6), with single semicircular canal BPPV (n=11) and BPPV without Meniere' s disease group(Control,n=43). All patients were diagnosed by the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. Result: Unilateral semicircular canal BPPV was more than bilateral BPPV, the posterior semicircular canal was the most common canal involved, and multiple semicircular canal BPPV with Meniere' s disease patients needed repeated canalith repositioning procedure and had a higher recurrence rate.Conclusion:A lower success rate of treatment and a higher recurrence rate was found in BPPV patients with Meniere' s disease compared with those without Meniere' s disease . The recurrence rate is highest in multiple semicircular canal BPPV with Meniere' s disease.
Posterior Semicircular Canal
Cite
Citations (1)