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Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.

Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A - Int J Otolaryngol (2011)

Bottom Line: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics.It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test.Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers.

View Article: PubMed Central - PubMed

Affiliation: ENT Department, Tzanio General Hospital of Piraeus, Afentouli 1 and Zanni, 18536 Piraeus, Greece.

ABSTRACT
Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

No MeSH data available.


Related in: MedlinePlus

When canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla occurs (left ear), a similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases is observed during the supine roll test (the involved left horizontal canal is colored black). (a) Patient in supine position with debris in the short arm of the left horizontal canal. (b) When rotating the head towards the affected side, the particles move away from the cupula, which will undergo an ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. (c) When rotating the head towards the healthy side, the particles move towards the cupula, which will undergo an ampullopetal (stimulatory) deflection, triggering a more intense apogeotropic nystagmus.
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fig4: When canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla occurs (left ear), a similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases is observed during the supine roll test (the involved left horizontal canal is colored black). (a) Patient in supine position with debris in the short arm of the left horizontal canal. (b) When rotating the head towards the affected side, the particles move away from the cupula, which will undergo an ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. (c) When rotating the head towards the healthy side, the particles move towards the cupula, which will undergo an ampullopetal (stimulatory) deflection, triggering a more intense apogeotropic nystagmus.

Mentions: This BPPV variant may be caused by either cupulolithiasis, which manifests as apogeotropic persistent horizontal nystagmus [20], or, less frequently, by canalolithiasis, when the otoliths are located in the short arm of the horizontal semicircular canal, near the ampulla [18]. Cupulolithiasis (Figure 3(a)) is thought to play a greater role in horizontal canal BPPV than in the posterior canal variant and accounts for approximately 1/3 of the cases [14]. As otoconia is directly adherent to the cupula, the vertigo is intense and persists while the head is in the provocative position. When the patient's head is turned toward the affected side (Figure 3(b)), the cupula will undergo an ampullofugal (inhibitory) deflection causing an apogeotropic nystagmus. Turning the head to the opposite side (Figure 3(c)) will result in ampullopetal (stimulatory) deflection, manifesting as a stronger apogeotropic nystagmus. To summarize, horizontal canal BPPV owed to cupulolithiasis manifests as bilateral apogeotropic horizontal nystagmus, which is more pronounced on the healthy side. This is explained by Ewald's second law [21], according to which excitation of the horizontal canal is a more potent stimulus than inhibition. In several cases, instead of cupulolithiasis, canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla may occur [18], presenting with similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases (Figure 4).


Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus.

Balatsouras DG, Koukoutsis G, Ganelis P, Korres GS, Kaberos A - Int J Otolaryngol (2011)

When canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla occurs (left ear), a similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases is observed during the supine roll test (the involved left horizontal canal is colored black). (a) Patient in supine position with debris in the short arm of the left horizontal canal. (b) When rotating the head towards the affected side, the particles move away from the cupula, which will undergo an ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. (c) When rotating the head towards the healthy side, the particles move towards the cupula, which will undergo an ampullopetal (stimulatory) deflection, triggering a more intense apogeotropic nystagmus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC3139887&req=5

fig4: When canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla occurs (left ear), a similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases is observed during the supine roll test (the involved left horizontal canal is colored black). (a) Patient in supine position with debris in the short arm of the left horizontal canal. (b) When rotating the head towards the affected side, the particles move away from the cupula, which will undergo an ampullofugal (inhibitory) deflection, triggering an apogeotropic horizontal nystagmus. (c) When rotating the head towards the healthy side, the particles move towards the cupula, which will undergo an ampullopetal (stimulatory) deflection, triggering a more intense apogeotropic nystagmus.
Mentions: This BPPV variant may be caused by either cupulolithiasis, which manifests as apogeotropic persistent horizontal nystagmus [20], or, less frequently, by canalolithiasis, when the otoliths are located in the short arm of the horizontal semicircular canal, near the ampulla [18]. Cupulolithiasis (Figure 3(a)) is thought to play a greater role in horizontal canal BPPV than in the posterior canal variant and accounts for approximately 1/3 of the cases [14]. As otoconia is directly adherent to the cupula, the vertigo is intense and persists while the head is in the provocative position. When the patient's head is turned toward the affected side (Figure 3(b)), the cupula will undergo an ampullofugal (inhibitory) deflection causing an apogeotropic nystagmus. Turning the head to the opposite side (Figure 3(c)) will result in ampullopetal (stimulatory) deflection, manifesting as a stronger apogeotropic nystagmus. To summarize, horizontal canal BPPV owed to cupulolithiasis manifests as bilateral apogeotropic horizontal nystagmus, which is more pronounced on the healthy side. This is explained by Ewald's second law [21], according to which excitation of the horizontal canal is a more potent stimulus than inhibition. In several cases, instead of cupulolithiasis, canalolithiasis of the short arm of the horizontal semicircular canal near the ampulla may occur [18], presenting with similar nystagmus (bilateral apogeotropic) as in the cupulolithiasis cases (Figure 4).

Bottom Line: Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics.It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test.Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers.

View Article: PubMed Central - PubMed

Affiliation: ENT Department, Tzanio General Hospital of Piraeus, Afentouli 1 and Zanni, 18536 Piraeus, Greece.

ABSTRACT
Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

No MeSH data available.


Related in: MedlinePlus