Atypical Forms of Paroxysmal Positional Nystagmus

1995 ◽  
Vol 74 (9) ◽  
pp. 649-656 ◽  
Author(s):  
Eric E. Smouha ◽  
Claudia Roussos
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Clinical Course ◽  
Positional Nystagmus ◽  
Cns Disorders ◽  
Duration Of Symptoms ◽  
Favorable Prognosis ◽  
Positional Vertigo ◽  
Vascular Insufficiency ◽  
Physical Findings ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo, and has a typical constellation of physical findings. Atypical forms of paroxysmal positional nystagmus (APPN) also exist, and are thought to represent conditions which are in fact not “benign”. We studied 100 consecutive patients with positional vertigo in order to learn whether APPN differed from classic BPPV in etiology or clinical fate, and to learn the incidence of central nervous system (CNS) disorders in these patients. APPN was present in 38% of these patients with diverse causes. One-fourth had CNS disorders or vascular insufficiency, the remainder, otogenic or idiopathic. APPN was more likely than BPPV to have a prolonged (persistent or recurring) clinical course. Although most cases eventually resolved, duration of symptoms tended to be longer, regardless of etiology. We conclude that APPN has a less favorable prognosis than typical BPPV, and that a CNS etiology should be suspected in prolonged cases.

scholarly journals BENIGN PAROXYSMAL POSITIONAL VERTIGO: OUR EXPERIENCE AT A TERTIARY CARE CENTRE OF CENTRAL INDIA

2020 ◽  
pp. 1-3
Author(s):  
Patel Meghraj Singh
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Tertiary Care ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Duration Of Symptoms ◽  
Common Cause ◽  
Patient Profile ◽  
Positional Vertigo ◽  
Age Range ◽  
Paroxysmal Positional Vertigo

Background: - Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. The diagnosis is often delayed and patients are unnecessarily investigated and treated with drugs. Aim: To analyze the patient profile, duration of symptoms, etiology, associated co-morbidities, type of canal involvement and response to CRP in cases of BPPV. Material & Methods: The present prospective study was conducted at a tertiary care centre from January 2015 to December 2016 in 90 patients with a clinical diagnosis of BPPV. Patient particular and disease specific data were recorded in preset profoma and analyzed. All these patients were treated by different CRP specific for the canal involved. All cases were reassessed for post procedural response. Results: Total 90 patients were included in the study with age range of 20 to 76 year. Mean age was 46.74. Maximum patients (26.67%) were in the age range of 41-50 year with male: female was 1:1.43. The duration of symptoms was in from 2 days to more than 3 years. Most common morbidity was diabetes and most common cause was Idiopathic (82.22%). Most of these patients presented with positional vertigo (94.44%). Right posterior canal was involved in 52 cases (57.78%) and left in 30 (33.33%) cases. Conclusion: BPPV is a common cause of vertigo. More awareness needed about its symptoms, early application of Dix-Hallpike test and Epley’s procedure to reduce the suffering of patients and to reduce unnecessary diagnostic tests and costs.

Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres

2006 ◽  
Vol 120 (7) ◽  
pp. 528-533 ◽  
Author(s):  
S Korres ◽  
D G Balatsouras ◽  
E Ferekidis
Keyword(s):  
Treatment Outcome ◽  
Prognostic Factors ◽  
Retrospective Study ◽  
Benign Paroxysmal Positional Vertigo ◽  
Duration Of Symptoms ◽  
Repeat Treatment ◽  
Positional Vertigo ◽  
Small Subgroup ◽  
Duration Of Disease ◽  
Paroxysmal Positional Vertigo

Objective: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs).Material and methods: Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences.Results: One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystagmographic findings and improper performance of manoeuvres had a significant effect both on initial and repeat treatment, but not on recurrences. Sex and duration of symptoms had no effect.Conclusion: Canalith repositioning procedures provide fast and long-lasting treatment of BPPV in most patients. However, in a small subgroup of patients, failures may be noticed that may be attributed to various prognostic factors.

scholarly journals Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants

2012 ◽  
Vol 4 (1) ◽  
pp. 25-40 ◽  
Author(s):  
Giacinto Asprella Libonati
Keyword(s):  
Differential Diagnosis ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Diagnosis And Therapy ◽  
Positional Vertigo ◽  
Peripheral Origin ◽  
Paroxysmal Positional Vertigo

ABSTRACT This article reviews the causes of positional vertigo and positional nystagmus of peripheral origin. Benign paroxysmal positional vertigo is described in all its variants, its diagnosis and therapy are highlighted. In addition, nonparoxysmal positional vertigo and nystagmus due to light/heavy cupula of lateral and posterior semicircular canal is focused on. The differential diagnosis between positional vertigo due to otolithic and nonotolithic causes is discussed. How to cite this article Asprella Libonati G. Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants. Int J Otorhinolaryngol Clin 2012;4(1):25-40.

scholarly journals Case Report: Bow Hunter Syndrome—One Reason to Add Non-gravity Dependent Positional Nystagmus Testing to Your Clinical Neuro-Otologic Exam

2021 ◽  
Vol 12 ◽  
Author(s):  
Michael C. Schubert ◽  
Nathaniel Carter ◽  
Sheng-fu Larry Lo
Keyword(s):  
Computed Tomography ◽  
Benign Paroxysmal Positional Vertigo ◽  
Hunter Syndrome ◽  
Downbeat Nystagmus ◽  
Positional Nystagmus ◽  
Imaging Studies ◽  
Positional Vertigo ◽  
Dependent Position ◽  
Paroxysmal Positional Vertigo

This case study describes transient downbeat nystagmus with vertigo due to a bilateral Bow Hunters Syndrome that was initially treated for 7 months as a peripheral benign paroxysmal positional vertigo. Normal static angiography and imaging studies (magnetic resonance, computed tomography) contributed to the mis-diagnosis. However, not until positional testing with the patient in upright (non-gravity dependent) was a transient downbeat nystagmus revealed with vertigo. The patient was referred for neurosurgical consult. Unfortunately, surgery was delayed due to suicidal ideation and hospitalization. Eventually, vertigo symptoms resolved following a C4-5 anterior cervical dissection and fusion. This case highlights the critical inclusion of non-gravity dependent position testing as an augment to the positional testing component of the clinical examination as well as the extreme duress that prolonged positional vertigo can cause.

Use of Vestibular Rehabilitation in the Treatment of Benign Paroxysmal Positional Vertigo

2020 ◽  
Vol 5 (4) ◽  
pp. 917-939
Author(s):  
Richard A. Clendaniel
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Semicircular Canals ◽  
Signs And Symptoms ◽  
Positional Nystagmus ◽  
Test Procedures ◽  
Horizontal Semicircular Canal ◽  
Treatment Techniques ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Purpose The purposes of this article are (a) to describe the different test procedures for benign paroxysmal positional vertigo (BPPV) and (b) to provide guidance for the treatment of the various forms of BPPV and to discuss the efficacy of the different interventions. Conclusions While BPPV primarily occurs in the posterior semicircular canal, it is also seen in the anterior and horizontal semicircular canals. There are distinctive patterns of nystagmus that help identify the affected semicircular canal and to differentiate between cupulolithiasis and canalithiasis forms of BPPV. There is reasonable evidence to support the different treatments for both posterior and horizontal semicircular canal BPPV. Anterior semicircular canal BPPV is rare, and as a consequence, there is little evidence to support the various treatment techniques. Finally, while BPPV is generally easy to identify, there are central causes of positional nystagmus with and without vertigo, which can complicate the diagnosis of BPPV. The signs and symptoms of BPPV are contrasted with those of the central causes of positional nystagmus.

scholarly journals Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal

2012 ◽  
Vol 69 (8) ◽  
pp. 669-674 ◽  
Author(s):  
Snezana Babac ◽  
Nenad Arsovic
Keyword(s):  
Success Rate ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Spontaneous Nystagmus ◽  
Posterior Semicircular Canal ◽  
Duration Of Symptoms ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
Repositioning Maneuver ◽  
Paroxysmal Positional Vertigo

Background/Aim. Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p- BPPV) and to discover possible causes of failure. Methods. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. Results. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver?s success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. Conclusion. The Epley maneuver is very successful repositioning procedure in treating p- BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV.

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