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.

scholarly journals Persistent Upbeat Positional Nystagmus in a Patient with Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Akihide Ichimura ◽  
Shigeto Itani
Keyword(s):  
Supine Position ◽  
Benign Paroxysmal Positional Vertigo ◽  
Semicircular Canals ◽  
Downbeat Nystagmus ◽  
Positional Vertigo ◽  
Head Roll ◽  
The Right ◽  
Upbeat Nystagmus ◽  
Torsional Nystagmus ◽  
Paroxysmal Positional Vertigo

Here, we report a patient with persistent positional upbeat nystagmus in a straight supine position with no evident abnormal central nervous system findings. A 43-year-old woman with rotatory positional vertigo and nausea visited our clinic 7 days after the onset. Initially, we observed persistent upbeat nystagmus in straight supine position with a latency of 2 s during the supine head roll test. However, an upbeat nystagmus disappeared on turning from straight to the left ear-down supine position, and while turning from the left to right ear-down position, an induced slight torsional nystagmus towards the right for >22 s was observed. In the Dix–Hallpike test, the left head-hanging position provoked torsional nystagmus towards the right for 50 s. In prone seated position, downbeat nystagmus with torsional component towards the left was observed for 45 s. Neurological examination and brain computed tomography revealed no abnormal findings. We speculated that persistent positional upbeat nystagmus in this patient was the result of canalolithiasis of benign paroxysmal positional vertigo of bilateral posterior semicircular canals.

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.

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.

Prolonged Positional Downbeat Nystagmus in Benign Paroxysmal Positional Vertigo: A Case Report and Literature Review

2021 ◽  
pp. 1-6
Author(s):  
Hyun-Jin Lee ◽  
Seong Ki Ahn ◽  
Chae Dong Yim ◽  
Seong Dong Kim ◽  
Dong Gu Hur
Keyword(s):  
Medical Records ◽  
Unusual Case ◽  
Benign Paroxysmal Positional Vertigo ◽  
Clinical Manifestations ◽  
Careful Consideration ◽  
Downbeat Nystagmus ◽  
Positional Vertigo ◽  
Torsional Component ◽  
Anterior Canal ◽  
Paroxysmal Positional Vertigo

Purpose This study aimed to report an unusual case of benign paroxysmal positional vertigo (BPPV), who showed prolonged positional downbeat nystagmus without latency and was diagnosed with cupulolithiasis of the anterior canal (AC). We compared this case with one of typical AC-BPPV, and possible mechanisms underlying the atypical characteristics were discussed. Method Two patients diagnosed with AC-BPPV were reported. Positional testing using video-oculography goggles was performed, and outcomes were measured via medical records and analysis of videos of the nystagmus. Results Downbeat nystagmus was observed in the contralateral Dix–Hallpike test in both cases. The torsional component was subtle or absent, but motion was induced toward the affected ear. The two cases differed in latency and duration of vertigo, as well as habituation. The patient with atypical nystagmus showed little or no latency and longer duration. Moreover, there was no habituation on repeated tests. The nystagmus showed several differences from that of typical AC-BPPV. Conclusions Based on our case, AC-BPPV may induce various unusual clinical manifestations of nystagmus. Accurate diagnosis requires careful consideration of the patient's symptoms and the characteristics of the nystagmus. Supplemental Material https://doi.org/10.23641/asha.14265356

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