Apogeotropic Variant of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

2013 ◽  
Vol 34 (6) ◽  
pp. 1155-1164 ◽  
Author(s):  
Maria Riga ◽  
Stavros Korres ◽  
George Korres ◽  
Vasilios Danielides
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Lateral Semicircular Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

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

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242580
Author(s):  
Hyun-Jin Lee ◽  
Seong Ki Ahn ◽  
Chae Dong Yim ◽  
Dae Hwan Kim ◽  
Dong Gu Hur
Keyword(s):  
Treatment Outcome ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Spontaneous Nystagmus ◽  
Sitting Position ◽  
Lateral Semicircular Canal ◽  
Video Oculography ◽  
Positional Vertigo ◽  
End Of Treatment ◽  
Paroxysmal Positional Vertigo

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.

Diagnosis and Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

2005 ◽  
Vol 133 (2) ◽  
pp. 278-284 ◽  
Author(s):  
Judith A. White ◽  
Kathleen D. Coale ◽  
Peter J. Catalano ◽  
John G. Oas
Keyword(s):  
Treatment Outcomes ◽  
Study Design ◽  
Retrospective Review ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Diagnostic Testing ◽  
Positional Nystagmus ◽  
Lateral Semicircular Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Objective: Describe the diagnosis, treatment, and outcome of a group of 20 patients with lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). Study Design and Setting: Retrospective review of 20 patients with LSC-BPPV (10 with geotropic and 10 with apogeotropic nystagmus) presenting to a tertiary balance center. Diagnosis was confirmed with infrared nystagmography in Dix-Hallpike positioning tests and supine positional tests. Patients were treated with one or more particle repositioning maneuvers. Results: Addition of supine positional nystagmus tests to Dix-Hallpike positioning testing improves sensitivity in the diagnosis of LSC-BPPV. Treatment outcomes in the apogeotropic LSC-BPPV group were poorer than the geotropic LSC-BPPV group. Significance: Adding supine positional testing to routine vestibular diagnostic testing will increase the identification of LSC-BPPV. Apogeotropic LSC-BPPV is more challenging to treat.

scholarly journals Nystagmus intensity and direction in bow and lean test: an aid to diagnosis of lateral semicircular canal benign paroxysmal positional vertigo

2016 ◽  
Vol 36 (6) ◽  
pp. 520-526
Author(s):  
V. Marcelli
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
A Priori ◽  
Sono State ◽  
Lateral Semicircular Canal ◽  
Positional Vertigo ◽  
Sono Stati ◽  
Paroxysmal Positional Vertigo

L’obiettivo è stato valutare bed side l’intensità e la direzione del nistagmo (NID) nelle due differenti posizioni del “bow and lean test” (BLT) per differenziare la forma geotropa dalla forma apogeotropa e determinare il lato affetto in caso di vertigine parossistica da posizionamento benigna idiopatica da litiasi a carico del canale semicircolare laterale (LSC-BPPV), prima ancora di utilizzare le classiche manovre diagnostiche. Sono stati esaminati 32 soggetti affetti da LSC-BPPV, in ognuno dei quali sono state valutate l’intensità e la direzione del nistagmo nelle due posizioni del BLT. L’intensità del nistagmo consente di differenziare la forma geotropa della forma apogeotropa mentre la direzione del nistagmo consente di indentificare il lato affetto. Per le noti legge che governano la fisiopatologia del CSL, un nistagmo più intenso in flessione del capo (bow) rispetto all’estensione (lean) indica un flusso ampullipeto e quindi la presenza di materiale flottante nel braccio non ampollare, tipico della forma geotropa. In tal caso, se il nistagmo in flessione (bow) è diretto a sinistra, il materiale flottante deve necessariamente occupare il braccio non ampollare del CSL sinistro; viceversa se il nistagmo in flessione è diretto a destra. D’altro canto, un nistagmo più intenso in estensione del capo (lean) rispetto alla flessione (bow) indica un flusso ampullifugo e quindi la presenza di materiale aderente alla cupola (cupololitiasi) o flottante nel braccio ampollare (canalolitiasi), tipico della forma apogeotropa. In tal caso, se il nistagmo in estensione (lean) è diretto a sinistra, il materiale flottante deve necessariamente occupare il braccio ampollare del CSL sinistro; viceversa se il nistagmo in estensione è diretto a destra. Come regola generale, in entrambe le forme la direzione del nistagmo con maggiore intensità indica il lato affetto. Il “NID-BLT” è risultato efficace nell’identificare la forma ed il lato affetto in ventidue soggetti su ventotto (79% del campione). In caso di LSC-BPPV, la corretta esecuzione ed interpretazione del “NID-BLT” fornisce un importante aiuto nello stabilire la forma (geotropa versus apogeotropa) e la sede (destra versus sinistra) nella maggior parte dei pazienti, prima ancora di utilizzare le classiche manovre diagnostiche. A differenza del test di Choung, che richiede di conoscere a priori se il paziente ha una forma geotropa o apogeotropa, il nostro test consente di formulare direttamente la diagnosi o di fornire elementi indispensabili nei casi in cui la diagnosi di lato è dubbia, mentre il paziente è ancora in posizione seduta.

scholarly journals Apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo: Where are the particles?

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Bernardo Faria Ramos ◽  
Renato Cal ◽  
Camila Martins Brock ◽  
Pedro Luiz Mangabeira Albernaz ◽  
Francisco Zuma e Maia
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Lateral Semicircular Canal ◽  
Horizontal Semicircular Canal ◽  
Positional Vertigo ◽  
New Treatment ◽  
Floating Particles ◽  
Paroxysmal Positional Vertigo

The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to free floating particles in the anterior arm of the lateral semicircular canal – particles attached to the cupula facing the canal or particles attached to the cupula facing the utricle. Zuma e Maia described a new treatment for both canalithiasis of the anterior arm of the horizontal semicircular canal (HC) and cupulolithiasis of the HC. Seventeen patients with apogeotropic HC-BPPV were enrolled and treated with Zuma’s Maneuver. During the repositioning of the particles to the utricule, we observed the direction of the nystagmus evoked in each step of this maneuver in order to know where the otoliths were probably located. Eight patients were diagnosed with canalithiasis of the anterior arm, six patients with cupulolithiasis with the particles facing the canal and three patients with cupulolithiasis with the particles facing the utricle. Our data suggest that we can assume where the otoliths are probably located by observing the pattern of the nystagmus evoked in each step of the Zuma’s Maneuver in patients with apogeotropic HC-BPPV.

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