scholarly journals Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo Presenting with Torsional Downbeating Nystagmus: An Apogeotropic Variant

2012 ◽  
Vol 2012 ◽  
pp. 1-9 ◽  
Author(s):  
Paolo Vannucchi ◽  
Rudi Pecci ◽  
Beatrice Giannoni
Keyword(s):  
Semicircular Canal ◽  
Distal Portion ◽  
Clinical Findings ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Anterior Semicircular Canal ◽  
Physical Therapies ◽  
Floating Particles ◽  
Paroxysmal Positional Vertigo

The aim of this study is to verify the hypothesis that free-floating particles could sometimes localize into the distal portion of the non ampullary arm of the posterior semicircular canal (PSC) so that assuming the Dix-Hallpike’s positions, the clot could move towards the ampulla eliciting a inhibitory torsional-down beating paroxysmal positional nystagmus (PPNy), instead of typical excitatory torsional-up beating PPNy. Among 45 patients with vestibular signs suggesting anterior semicircular canal paroxysmal positional vertigo (PPV), collected from February 2003 to August 2006, we detected a group of 6 subjects whose clinical findings showed a singular behaviour during follow-up. At the first check-up, all patients were submitted to different types of physical manoeuvres for ASC canalolithiasis. Patients were controlled during the same session and after one week. When we found that nystagmus was qualitatively changed we adopted the appropriate physical therapies for that sign. At a next check-up, after having performed some physical therapies, all patients had a typical PSC PPNy of the opposite side, with respect to that of the ASC initially diagnosed. Basing on these observations we conclude that PSC PPV, similarly to lateral semicircular canal PPV, could manifests in a apogeotropic variant.

scholarly journals A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

2020 ◽  
Author(s):  
Ajay Kumar Vats ◽  
Sudhir Kothari ◽  
Anirban Biswas
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
History Of ◽  
Anterior Semicircular Canal ◽  
The Right ◽  
Paroxysmal Positional Vertigo

AbstractIn any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnostic or therapeutic positioning maneuvers for the purported ASC-BPPV, the positional oculomotor pattern changes to an upbeating nystagmus with the reversal in the direction of the torsion as well, localizing it to the contralateral PSC with respect to the ASC initially diagnosed. The initial oculomotor pattern observed on the right Dix–Hallpike test in this patient, of a short latency downbeating left torsional (from the patient’s perspective) positional nystagmus suggested a diagnosis of left ASC-BPPV, which was accordingly treated with multiple sessions of reverse Epley maneuvers daily for a week. At the end of the week, a verifying right Dix–Hallpike test elicited an upbeating right torsional (from the patient’s perspective) positional nystagmus. It is extremely unlikely that this patient had resolution of her initial left ASC-BPPV with the daily sessions of reverse Epley maneuvers carried over a week and immediately suffered from commoner geotropic variant of the right PSC-BPPV (geo-PSC-BPPV). It is plausible to interpret that this patient suffered from the right apo-PSC-BPPV from the very outset, and the reverse Epley maneuver performed for the ostensive left ASC-BPPV led to an intracanal shift of otoconial debris from its nonampullary to the ampullary arm resulting in right geo-PSC-BPPV. The reasons why situations like this outwit the clinician resulting in inaccurate localization as well as lateralization is discussed. The patient was successfully treated with right Epley maneuver after transformation to geo-PSC-BPPV and was asymptomatic at follow-up for 4 weeks. A peripheral p-DBN with torsional component in any patient with a history of positionally triggered vertigo can be either ASC-BPPV or apo-PSC-BPPV. A very close follow-up at a short interval of time with meticulously executed positional tests is the only definitive way to differentiate the two conditions.

scholarly journals The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: A short-term comparative study

2021 ◽  
Vol 9 (3) ◽  
pp. 75-80
Author(s):  
Mustafa Caner Kesimli
Keyword(s):  
Comparative Study ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Short Term ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
The One ◽  
Paroxysmal Positional Vertigo

OBJECTIVE: This study aimed to compare the effectiveness of the Epley maneuver with the Semont maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo and observe differences in the resolution time of symptoms in the short-term follow-up. METHODS: Sixty patients with posterior semicircular canal benign paroxysmal positional vertigo (23 males, 37 females; median age: 44.9 years; range, 14 to 80 years) were included in the prospective randomized comparative study conducted in our clinic between April 2019 and October 2019. Diagnosis and treatment maneuvers were performed under videonystagmography examination. Participants were randomly selected after the diagnostic tests for the Epley maneuver and the Semont maneuver treatment groups. RESULTS: In the evaluation of vertigo with videonystagmography, 25 (83.3%) patients in the Epley maneuver group and 20 (66.6%) patients in the Semont maneuver group recovered in the one-week follow-up, and 28 (93.3%) patients in the Epley maneuver group and 24 (80%) patients in the Semont maneuver group recovered in the two-week follow-up. All patients in the Epley maneuver group recovered at the end of one month; four patients in the Semont maneuver group still had vertiginous symptoms (100% vs. 86.6%, p=0.04). There was a statistically significant difference between the Epley and Semont groups regarding visual analog scores at the one-week, two-week, and one-month follow-ups (p=0.002, p<0.001, p=0.001, respectively). CONCLUSION: The Epley maneuver was significantly more effective than the Semont maneuver in resolving vertigo in the short-term treatment of posterior semicircular canal benign paroxysmal positional vertigo.

Evolution of Treatment Maneuvers for Benign Paroxysmal Positional Vertigo

2016 ◽  
Author(s):  
Robert W. Baloh
Keyword(s):  
21St Century ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Initial Examination ◽  
Positional Vertigo ◽  
Anterior Semicircular Canal ◽  
Paroxysmal Positional Vertigo

Near the turn of the 21st century, as more physicians began performing the Epley and Semont maneuvers for treatment of benign paroxysmal positional vertigo (BPPV), it became apparent that the procedures could be done at the time of initial examination without the need for sedation or vibration. Furthermore, modified versions of the maneuvers evolved that were more effective and easier to perform. There are clear similarities in these modified repositioning maneuvers. BPPV nearly always results from otoconial debris within the posterior semicircular canal because this is the canal in which it is most easily trapped. Although less common, there are horizontal and anterior semicircular canal variants of BPPV, and otolithic debris can become attached to the cupula, producing a true cupulolithiasis. The nystagmus is in the plane of the affected canal; the nystagmus is transient when the debris is freely floating and persistent when debris is attached to the cupula.

Particle Repositioning Maneuver for Benign Paroxysmal Positional Vertigo

1993 ◽  
Vol 102 (5) ◽  
pp. 325-331 ◽  
Author(s):  
Lorne S. Parnes ◽  
R. Greg Price-Jones
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Poor Response ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Lost To Follow Up ◽  
Repositioning Maneuver ◽  
Simple Bedside ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is a common, most often self-limited, vestibular end organ disorder that in some cases may be quite disabling. Recent evidence suggests that some, if not most, cases result from free-floating posterior semicircular canal endolymph particles. We postulate that the particle repositioning maneuver displaces these particles from the posterior canal through the common crus into the utricle, where they no longer induce pathologic responses. Our report focuses on 38 consecutive patients treated with this simple bedside technique during a 10-month period. On follow-up, 26 patients (68.4%) were free of disease, 4 (10.5%) were significantly improved, 4 (10.5%) remained unchanged, and 4 (10.5%) were lost to follow-up. Of the 4 patients who remained unchanged, 2 underwent successful posterior semicircular canal occlusions. The direction of the nystagmus during the second stage of the maneuver appears important in predicting the efficacy, with reversal of nystagmus denoting a poor response. These findings provide additional insight into the pathophysiology of this disorder.

Non-ampullary pluging of the posterior semicircular canal for being paroxysmal positional vertigo

1991 ◽  
Vol 105 (11) ◽  
pp. 901-906 ◽  
Author(s):  
Albert Pace-Balzan ◽  
John A. Rutka
Keyword(s):  
Surgical Treatment ◽  
Semicircular Canal ◽  
Effective Alternative ◽  
Common Condition ◽  
Posterior Semicircular Canal ◽  
Nerve Section ◽  
Positional Vertigo ◽  
Semicircular Canal Occlusion ◽  
Paroxysmal Positional Vertigo

AbstractBenign paroxysman positinal vertigo (BPPV) is a common condition which is usually self-limiting. Surgical treatment is rarely required and for many years the mainstay of such treatment has been singular neurectomy (posterior ampullary nerve section).A new operation has recently been described for the treatment of BPPV involving occlusion of the posterior semicircular canal. We have performed this operation on five patients with intractable BPPV and report our result with follow up of between 12 and 36 months from operation.The excellent results of posterior semicircular canal occlusion which have been previously reposted in the literature are confirmed by our experience. In our opinion the operation is a safe and effective alternative to singular neurectomy.

Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report

2009 ◽  
Vol 124 (5) ◽  
Author(s):  
S-Z Lin ◽  
J-P Fan ◽  
A-H Sun ◽  
J Guan ◽  
H-B Liu ◽  
...  
Keyword(s):  
Case Report ◽  
Semicircular Canal ◽  
World Literature ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Long Term Effect ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To observe the long-term effect of laser occlusion of the posterior semicircular canal for benign paroxysmal positional vertigo.Method:Case report and review of the relevant world literature.Results:We treated a patient with refractory benign paroxysmal positional vertigo using laser occlusion of the posterior semicircular canal, and achieved satisfactory results. Three months after the operation, the patient was able to lead a normal life. There was no recurrence over five years of follow up.Conclusion:To our knowledge, this is the first report in the world literature of a patient with refractory benign paroxysmal positional vertigo being treated with laser occlusion of the posterior semicircular canal. This method had long-term effectiveness, and may be one of the most effective methods of treating patients with refractory benign paroxysmal positional vertigo.

Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo

1994 ◽  
Vol 108 (11) ◽  
pp. 935-939 ◽  
Author(s):  
Maurice Hawthorne ◽  
Mohamed El-Naggar
Keyword(s):  
Semicircular Canal ◽  
High Frequency ◽  
Benign Paroxysmal Positional Vertigo ◽  
Sensorineural Hearing ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Patient Reported ◽  
Paroxysmal Positional Vertigo

AbstractA series of 15 patients with intractable benign paroxysmal positional vertigo (BPPV) who had fenestration and occlusion of the posterior semicircular canal (FOP) surgery commencing in December 1990 are reported. Follow-up was from 14 to 40 months. All patients reported a cure of their positional vertigo. No patient regretted having the surgery. All patients had a negative Dix-Hallpike test post-operatively and the test remained negative for the duration of follow-up. Eight patients had a mild high frequency sensorineural hearing (SNHL) loss post-operatively which had almost recovered six months later. No patient reported any change in their hearing following surgery. Of the 10 patients who did not have pre-operative tinnitus, developed tinnitus but it was not considered significant by them. All patients developed mild unsteadiness following surgery which gradually improved with mobilization and physiotherapy if necessary.The operation preserves hearing, is technically straightforward, well-tolerated and effective.

Benign paroxysmal positional vertigo of the posterior semicircular canal: efficacy of Santiago treatment protocol, long-term follow up and analysis of recurrence

2012 ◽  
Vol 126 (4) ◽  
pp. 363-371 ◽  
Author(s):  
A Soto-Varela ◽  
M Rossi-Izquierdo ◽  
G Martínez-Capoccioni ◽  
T Labella-Caballero ◽  
S Santos-Pérez
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Treatment Protocol ◽  
First Year ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Long Term Follow Up ◽  
Paroxysmal Positional Vertigo

AbstractObjectives:To evaluate the efficacy of the Santiago treatment protocol for benign paroxysmal positional vertigo of the posterior semicircular canal, to analyse recurrence and to establish prognostic factors.Material and methods:Four hundred and twelve patients with unilateral benign paroxysmal positional vertigo of the posterior semicircular canal were treated with the Semont manoeuvre and, if symptoms did not resolve, successive application of three Epley manoeuvres plus Brandt–Daroff exercises.Results:Symptoms resolved in 404 patients (98.1 per cent); a single Semont manoeuvre was sufficient in 334 (81.2 per cent). Aetiology had no impact on resolution of symptoms or number of manoeuvres required. The estimated likelihood of recurrence was 14 per cent in the first year and 27 per cent after 10 years. The only factor indicating a worse prognosis was recurrence.Conclusion:In unilateral benign paroxysmal positional vertigo of the posterior semicircular canal, the above treatment protocol cured 98 per cent of patients. More than half of recurrences occurred in the first year. None of the analysed factors increased the likelihood of recurrence.

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