Down-Beating Nystagmus in Anterior Canal Benign Paroxysmal Positional Vertigo

2008 ◽  
Vol 19 (03) ◽  
pp. 257-266 ◽  
Author(s):  
David A. Zapala
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Benign Paroxysmal Positional Vertigo ◽  
Signs And Symptoms ◽  
Central Nervous System Disease ◽  
Positional Nystagmus ◽  
Central Nervous System Dysfunction ◽  
Positional Vertigo ◽  
Anterior Canal ◽  
Paroxysmal Positional Vertigo

Down-beating positional nystagmus is typically associated with central nervous system disease. Anterior canal benign paroxysmal positional vertigo (AC-BPPV) can mimic down-beating positional nystagmus of central origin, particularly when it is bilateral. Factors that increase the probability of bilateral AC-BPPV include a history of bilateral multicanal BPPV, transient down-beating and torsional nystagmus that follows the plane of the provoked canal, and the absence of co-occurring neurologic signs and symptoms of central nervous system dysfunction. With neurologic clearance for canalith repositioning, exploration for AC-BPPV and canalith repositioning trials may alleviate symptoms even when the nystagmus does not appear to fatigue. In the case presented, the use of a side-lying maneuver with the nose down to provoke AC-BPPV symptoms and the use of a reversed Epley to clear AC-BPPV symptoms are highlighted. This approach is helpful when the diagnosis is unclear and neck hyperextension is to be avoided. El nistagmo posicional de batida hacia abajo está típicamente asociado con enfermedades del sistema nervioso central. El vértigo posicional paroxístico benigno del canal anterior (AC-BPPV) puede simular un nistagmo posicional de batida hacia abajo de origen central, particularmente cuando es bilateral. Los factores que influyen sobre la probabilidad de un AC-BPPV bilateral incluyen una historia de BPPV multicanal bilateral, de nistagmo transitorio de batida hacia abajo o de nistagmo de torsión, que sigue el plano del canal provocado, y la ausencia de signos y síntomas neurológicos concurrentes por una disfunción del sistema nervioso central. Con una depuración neurológica de reposición canalicular, la exploración buscando AC-BPPV y los intentos de reposicionamiento canalicular pueden aliviar los síntomas aún cuando el nistagmo no parezca fatigarse. En el caso presentado, se destaca el uso de la maniobra de decúbito lateral con descenso de la nariz para provocar los síntomas del AC-BPPV. Este enfoque es útil cuando el diagnóstico no es claro y se debe evitar la hiperextensión del cuello.

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 Positional Vertigo and Nystagmus of Central Origin

1981 ◽  
Vol 8 (2) ◽  
pp. 133-137 ◽  
Author(s):  
P. Watson ◽  
H.O. Barber ◽  
J. Deck ◽  
K. Terbrugge
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Central Nervous System Disease ◽  
Positional Nystagmus ◽  
Posterior Fossa Tumors ◽  
System Disease ◽  
Positional Vertigo ◽  
Central Origin

SUMMARY:Four cases are described illustrating the clinical features of positional vertigo and nystagmus due to posterior fossa tumors and a case of obstructive hydrocephalus. In these cases positional vertigo was the first and only presenting symptom of central nervous system disease. One case of subependymoma of the fourth ventricle and one with hydrocephalus had characteristic symptoms of benign positional vertigo; each showed positional nystagmus of the benign paroxysmal type.

Diagnosis and treatment of anterior canal benign paroxysmal positional vertigo

2018 ◽  
Vol 57 (9) ◽  
pp. 673-680 ◽  
Author(s):  
Xia Ling ◽  
Kang-Zhi Li ◽  
Bo Shen ◽  
Li-Hong Si ◽  
Yuan Hong ◽  
...  
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Diagnosis And Treatment ◽  
Positional Vertigo ◽  
Anterior Canal ◽  
Paroxysmal Positional Vertigo

scholarly journals Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)

2017 ◽  
Vol 156 (3_suppl) ◽  
pp. S1-S47 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Samuel P. Gubbels ◽  
Seth R. Schwartz ◽  
Jonathan A. Edlow ◽  
Hussam El-Kashlan ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Benign Paroxysmal Positional Vertigo ◽  
Radiographic Imaging ◽  
Inappropriate Use ◽  
Central Nervous System Disorders ◽  
Positional Vertigo ◽  
Canalith Repositioning Procedure ◽  
Paroxysmal Positional Vertigo

Objective This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.

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.

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