scholarly journals Benign Positional Paroxysmal Vertigo in Children

2021 ◽  
Vol 11 (1) ◽  
pp. 47-54
Author(s):  
Cristiano Balzanelli ◽  
Daniele Spataro ◽  
Luca Oscar Redaelli de Zinis
Keyword(s):  
Daily Activities ◽  
Clinical Parameters ◽  
Pediatric Age ◽  
Balance Disorders ◽  
Horizontal Canal ◽  
Posterior Canal ◽  
Benign Positional Paroxysmal Vertigo ◽  
Vestibular Assessment ◽  
Anxiety And Fear ◽  
Anterior Canal

The aim of this study was to assess the prevalence and analyze clinical parameters of benign positional paroxysmal vertigo (BPPV) in a pediatric age. A cohort of 423 children under the age of 15 (median age 11. interquartile range 9–13) was submitted to vestibular assessment for balance disorders. Dix-Hallpike and Roll-Supine tests were performed to look for positioning nystagmus using video-infrared goggles. BPPV was found in 43 of 423 children evaluated for balance disorders (10.2%). There were 28 females (65.1%) and 15 (34.9%) males. The posterior canal was involved in 79% of cases and the horizontal canal in 21% of cases. No apogeotropic bilateral or anterior canal form were seen. Thus, BPPV is not an infrequent type of vertigo in children and must be evaluated as soon as possible in order to plan the most appropriate maneuver and restore daily activities as soon as possible, avoiding anxiety and fear.

Two conditions to fully recover dynamic canal function in unilateral peripheral vestibular hypofunction patients

2021 ◽  
pp. 1-15
Author(s):  
Michel Lacour ◽  
Alain Thiry ◽  
Laurent Tardivet
Keyword(s):  
Crucial Role ◽  
Recovery Process ◽  
Head Impulse Test ◽  
Additional Parameter ◽  
Vestibular Loss ◽  
Horizontal Canal ◽  
Lateral Canal ◽  
Gaze Stability ◽  
Vestibular Hypofunction ◽  
Anterior Canal

BACKGROUND: The crucial role of early vestibular rehabilitation (VR) to recover a dynamic semicircular canal function was recently highlighted in patients with unilateral vestibular hypofunction (UVH). However, wide inter-individual differences were observed, suggesting that parameters other than early rehabilitation are involved. OBJECTIVE: The aim of the study was to determine to what extent the degree of vestibular loss assessed by the angular vestibulo-ocular reflex (aVOR) gain could be an additional parameter interfering with rehabilitation in the recovery process. And to examine whether different VR protocols have the same effectiveness with regard to the aVOR recovery. METHODS: The aVOR gain and the percentage of compensatory saccades were recorded in 81 UVH patients with the passive head impulse test before and after early VR (first two weeks after vertigo onset: N = 43) or late VR (third to sixth week after onset: N = 38) performed twice a week for four weeks. VR was performed either with the unidirectional rotation paradigm or gaze stability exercises. Supplementary outcomes were the dizziness handicap inventory (DHI) score, and the static and dynamic subjective visual vertical. RESULTS: The cluster analysis differentiated two distinct populations of UVH patients with pre-rehab aVOR gain values on the hypofunction side below 0.20 (N = 42) or above 0.20 (N = 39). The mean gain values were respectively 0.07±0.05 and 0.34±0.12 for the lateral canal (p <  0.0001), 0.09±0.06 and 0.44±0.19 for the anterior canal (p <  0.0001). Patients with aVOR gains above 0.20 and early rehab fully recovered dynamic horizontal canal function (0.84±0.14) and showed very few compensatory saccades (18.7% ±20.1%) while those with gains below 0.20 and late rehab did not improve their aVOR gain value (0.16±0.09) and showed compensatory saccades only (82.9% ±23.7%). Similar results were found for the anterior canal function. Recovery of the dynamic function of the lateral canal was found with both VR protocols while it was observed with the gaze stability exercises only for the anterior canal. All the patients reduced their DHI score, normalized their static SVV, and exhibited uncompensated dynamic SVV. CONCLUSIONS: Early rehab is a necessary but not sufficient condition to fully recover dynamic canal function. The degree of vestibular loss plays a crucial role too, and to be effective rehabilitation protocols must be carried out in the plane of the semicircular canals.

Relationship of Semicircular Canal Size to Vestibular-Nerve Afferent Sensitivity in Mammals

2007 ◽  
Vol 98 (6) ◽  
pp. 3197-3205 ◽  
Author(s):  
Aizhen Yang ◽  
Timothy E. Hullar
Keyword(s):  
Semicircular Canal ◽  
High Frequency ◽  
High Gain ◽  
Vestibular Nerve ◽  
Radius Of Curvature ◽  
Horizontal Canal ◽  
Vestibular Nerve Afferents ◽  
The Relationship ◽  
Irregular Afferents ◽  
Anterior Canal

The relationship between semicircular canal radius of curvature and afferent sensitivity has not been experimentally determined. We characterized mouse semicircular canal afferent responses to sinusoidal head rotations to facilitate interspecies and intraspecies comparisons of canal size to sensitivity. The interspecies experiment compared the horizontal canal afferent responses among animals ranging in size from mouse to rhesus monkey. The intraspecies experiment compared afferent responses from the larger anterior canal to those from the smaller horizontal canal of mice. The responses of mouse vestibular-nerve afferents showed a low- and high-frequency phase lead and high-frequency gain enhancement. Regular horizontal-canal afferents showed a sensitivity to 0.5-Hz sinusoidal rotations of 0.10 ± 0.03 (SD) spike · s−1/deg · s−1 and high-gain irregular afferents showed a sensitivity of 0.25 ± 0.11 spike · s−1/deg · s−1. The interspecies comparison showed that the sensitivity of regular afferents was related to the radius of curvature R according to the formula Gr = 0.23R − 0.09 ( r2 = 0.86) and the sensitivity of irregular afferents was related to radius according to the formula Gi = 0.32R + 0.01 ( r2 = 0.67). The intraspecies comparison showed that regularly firing anterior canal afferents were significantly more sensitive than those from the relatively smaller horizontal canal, with Gr = 0.25R. This suggests that canal radius of curvature is closely related to afferent sensitivity both among and within species. If the relationship in humans is similar to that demonstrated here, the sensitivity of their regular vestibular-nerve afferents to 0.5-Hz rotations is likely to be about 0.67 spike · s−1/deg · s−1 and of their high-gain irregular afferents about 1.06 spikes · s−1/deg · s−1.

scholarly journals 004 Vestibular event monitoring in the emergency department

2019 ◽  
Vol 90 (e7) ◽  
pp. A2.1-A2
Author(s):  
Benjamin Nham ◽  
Nicole Reid ◽  
Emma Argaet ◽  
Allison Young ◽  
Kendall Bein ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Assessment ◽  
Vestibular Migraine ◽  
Slow Phase ◽  
Control Group ◽  
Event Monitoring ◽  
Horizontal Canal ◽  
Posterior Canal ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome

IntroductionAcute vertigo is often accompanied by ictal-nystagmus which may assist with diagnosis. We examine the merits of a structured assessment combined with vestibular event-monitoring in the Emergency Department (ED).MethodsWe undertook a structured clinical assessment and video-nystagmography in 220 non-consecutive patients presenting to a public-hospital ED with acute vertigo, during a 10-month period. The records of 115 consecutive vertiginous patients who underwent standard-assessment were compared.ResultsFor the structured assessment group: 54% presented with acute vestibular syndrome (AVS), 24% with episodic spontaneous vertigo (EVS), and 20% with recurrent positional-vertigo (RPV).For AVS (n=119), most common diagnoses were vestibular neuritis (34%), stroke (34%) and vestibular migraine (13%). Nystagmus slow-phase velocity (SPV) for VN, stroke and VM were 11±5.5o/s, 5.6±2.5o/s, 5.4±5.9o/s; Mean ipsilesional video-head impulse gains were 0.51±0.29, 0.89±0.20 and 0.96±0.13. For EVS(n=53), diagnoses included vestibular migraine (63%), Meniere’s Disease (11%) and others (26%). Nystagmus SPV was 5.4±3.6o/s, 7.6±6.3o/s, 4.1±1.5o/s. In RPV (n=43), common diagnoses were posterior-canal BPPV (66%), horizontal-canal BPPV (23%), migraine (7%). Positional nystagmus SPV profile showed Peak SPV of 42.5o/s, 77.6o/s, 20.64o/s and Time-constants of 6.52s, 22.51s, 34.56s for Posterior-canal BPPV, Horizontal-canal BPPV and Atypical Positional-Vertigo. A final diagnosis was reached in 96% of patients.In the ED control group, only 77% were separated into spontaneous or positional-vertigo. A diagnosis was provided in 57% and was concordant with the history and examination in 34%.ConclusionVestibular event-monitoring and structured clinical assessment secured a diagnosis in 96% of cases compared with 34% for the control group, reinforcing its merit.

scholarly journals Why Treat Apogeotropic BPPVs of the Horizontal Canal? About 30 Observations

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Philippe Lorin ◽  
Francois Foubert ◽  
Marie Debaty
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Rapid Recovery ◽  
Therapeutic Treatment ◽  
Short Term ◽  
Horizontal Canal ◽  
Posterior Canal ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV), of the horizontal canal, in the apogeotropic form (AHBPPV) was described in 1995. Based on 30 observations of typical AHBPPVs of the horizontal canal, we endeavor to discuss the relevance of physiotherapy.Material and Method.Thirty observations of typical apogeotropic BPPVs of the horizontal canal treated with a 360°barbeque rotation on the BPPV side, reviewed in consultation at 1 and 3 weeks and reevaluated the following year.Results.Our cohort of 30 patients had an average age of 58.6 years. The apogeotropic BPPVs of the horizontal canal, which can be transformed into BPPVs of the posterior canal or into geotropic-type BPPVs of the horizontal canal do not recover more quickly. Patients who follow the positional advice do not recover more quickly than those who do not (P  =  0.152). The 15 patients treated on average 13.73 days after the onset of the disease did not recover more quickly after the start of therapeutic treatment than those treated later (P  =  0.032).Conclusion.Here, we demonstrate that the direction of rotation during the maneuvers is of no importance for the results. We show that transformability is not a guarantee of rapid recovery and that the therapist’s effectiveness is limited when it comes to the short-term results.

scholarly journals The Use of Exergames in the Neurorehabilitation of People with Parkinson Disease: The Impact on Daily Life

2020 ◽  
Author(s):  
Bianca Simone Zeigelboim ◽  
Maria Renata José ◽  
Maria Izabel Rodrigues Severiano ◽  
Geslaine Janaína Bueno dos Santos ◽  
Helio Afonso Ghizoni Teive ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Cross Sectional Study ◽  
Daily Activities ◽  
Cross Sectional ◽  
Balance Confidence ◽  
Progressive Degeneration ◽  
Before And After ◽  
Vestibular Assessment ◽  
The Impact

Abstract Introduction Parkinson disease (PD) is a progressive degeneration characterized by motor disorders, such as tremor, bradykinesia, stiffness and postural instability. Objective To evaluate the independence, confidence and balance in the development of daily activities in patients with PD before and after rehabilitation. Methods A descriptive, retrospective cross-sectional study was carried out with 16 patients (mean 57.6 ± 18.7 years), submitted to anamnesis, otolaryngological evaluation and vestibular assessment. The Vestibular Disorders Activities of Daily Living (VADL) and the Activities-Specific Balance Confidence (ABC) scales were applied before and after rehabilitation with virtual reality. Results a) The instrumental subscale of the questionnaire showed statistically significant result (p = 0.022; 95% CI 1.21; 2.21) between the first and second assessments; b) The correlation between the questionnaires showed statistically significant result in the ambulation subscale (p = 0.011; 95% CI −0.85; −0.17) first and (p = 0.002, 95% CI −0.88; −0.31) second assessments, and the functional subscale was only verified in the second assessment (p = 0.011, 95% CI −0.85; −0.17); and c) The patients presented clinical improvement in the final assessment after rehabilitation with significant result for the tightrope walk (p = 0.034, 95% CI −12.5; −0.3) and ski slalom games (p = 0.005, 95% CI −34.8; −6.6). Conclusions Our results showed that the VADL and ABC questionnaires, applied before and after rehabilitation, were important tools to measure the independence, confidence and balance while developing daily activities. The VADL and ABC questionnaires may effectively contribute to quantify the effect of the applied therapeutics and, consequently, its impact on the quality of life of patients with PD.

Anterior canal neurons in cat vestibular nuclei have large phase leads during low frequency vertical axis pitch

2007 ◽  
Vol 16 (6) ◽  
pp. 245-256
Author(s):  
Sandra C. Brettler ◽  
James F. Baker
Keyword(s):  
Low Frequency ◽  
Vertical Axis ◽  
Vestibular Nuclei ◽  
Whole Body ◽  
Posterior Canal ◽  
Spatial Sensitivity ◽  
Ocular Reflex ◽  
Vestibular Afferents ◽  
Vestibulo Ocular Reflex ◽  
Anterior Canal

Vestibulo-ocular and second-order neurons in medial and superior vestibular nuclei of alert cats were identified by antidromic and orthodromic electrical stimulation, and their responses to whole body rotations were recorded in the dark. Neurons that had spatial sensitivity most closely aligned with the anterior canal (anterior canal neurons) were compared with neurons that had spatial sensitivity most closely aligned with the posterior canal (posterior canal neurons). Responses were recorded during low frequency earth-horizontal axis pitch rotations in the normal upright posture, and during earth-vertical axis pitch with the head and body lying on the left side. During upright pitch, response phases of anterior canal neurons slightly lagged those of posterior canal neurons or primary vestibular afferents, as previously reported. During on-side pitch, anterior canal neurons showed far greater phase leads with respect to head velocity than posterior canal neurons, primary vestibular afferents, or previously reported vestibulo-ocular reflex eye movements. These results provide challenges for vestibulo-ocular reflex models to incorporate central mechanisms for phase leads among the inputs to anterior canal neurons and to explain how the anterior canal neuron signals reported here combine with other signals to produce observed vestibulo-ocular reflex behavior.

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

2019 ◽  
Vol 40 (4) ◽  
pp. 494-498 ◽  
Author(s):  
Salvatore Martellucci ◽  
Giuseppe Attanasio ◽  
Massimo Ralli ◽  
Vincenzo Marcelli ◽  
Marco de Vincentiis ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Posterior Canal ◽  
Cervical Range Of Motion ◽  
Benign Positional Paroxysmal Vertigo

scholarly journals Pre-habilitation Before Vestibular Schwannoma Surgery—Impact of Intratympanal Gentamicin Application on the Vestibulo-Ocular Reflex

2021 ◽  
Vol 12 ◽  
Author(s):  
Alexander A. Tarnutzer ◽  
Christopher J. Bockisch ◽  
Elena Buffone ◽  
Alexander M. Huber ◽  
Vincent G. Wettstein ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Vestibular Function ◽  
Loss Of Function ◽  
Saccadic Amplitude ◽  
Vestibular Loss ◽  
Horizontal Canal ◽  
Ocular Reflex ◽  
Intratympanic Gentamicin ◽  
Vestibulo Ocular Reflex ◽  
Anterior Canal

Background: Patients with vestibular schwannoma that show residual peripheral-vestibular function before surgery may experience sudden and substantial vestibular loss of function after surgical resection. To alleviate the sudden loss of peripheral-vestibular function after vestibular-schwannoma (VS) resection, pre-surgical intratympanic gentamicin application was proposed.Objective: We hypothesized that this approach allows for a controlled reduction of peripheral-vestibular function before surgery but that resulting peripheral-vestibular deficits may be canal-specific with anterior-canal sparing as observed previously in systemic gentamicin application.Methods: Thirty-four patients (age-range = 27–70 y) with unilateral VS (size = 2–50 mm) were included in this retrospective single-center trial. The angular vestibulo-ocular reflex (aVOR) was quantified before and after (29.7 ± 18.7 d, mean ± 1SD) a single or two sequential intratympanic gentamicin applications by use of video-head-impulse testing. Both aVOR gains, cumulative saccadic amplitudes, and overall aVOR function were retrieved. Statistical analysis was done using a generalized linear model.Results: At baseline, loss of function of the horizontal (20/34) and posterior (21/34) canal was significantly (p &lt; 0.001) more frequent than that of the anterior canal (5/34). After gentamicin application, loss of function of the horizontal (32/34) or posterior (31/34) canal remained significantly (p ≤ 0.003) more frequent than that of the anterior canal (18/34). For all ipsilesional canals, significant aVOR-gain reductions and cumulative-saccadic-amplitude increases were noted after gentamicin. For the horizontal canal, loss of function was significantly larger (increase in cumulative-saccadic-amplitude: 1.6 ± 2.0 vs. 0.8 ± 1.2, p = 0.007) or showed a trend to larger changes (decrease in aVOR-gain: 0.24 ± 0.22 vs. 0.13 ± 0.29, p = 0.069) than for the anterior canal.Conclusions: Intratympanic gentamicin application resulted in a substantial reduction in peripheral-vestibular function in all three ipsilesional canals. Relative sparing of anterior-canal function noted at baseline was preserved after gentamicin treatment. Thus, pre-surgical intratympanic gentamicin is a suitable preparatory procedure for reducing the drop in peripheral-vestibular function after VS-resection. The reasons for relative sparing of the anterior canal remain unclear.

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