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A New Variant of Posterior Canal Benign Paroxysmal Positional Vertigo: A Nonampullary or Common Crus Canalolithiasis.

Yetiser S - Case Rep Otolaryngol (2015)

Bottom Line: Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before.We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth.Unexpected rotational direction may lead to confusion about the site.

View Article: PubMed Central - PubMed

Affiliation: Department of ORL, Anadolu Medical Center, 41400 Kocaeli, Turkey.

ABSTRACT
Clockwise or counterclockwise, rotational, upbeating nystagmus is seen in patients with posterior canal benign paroxysmal positional vertigo during left or right head-hanging test, respectively. Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before. We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth. Unexpected rotational direction may lead to confusion about the site. The examiner should be aware of this abnormal or atypical variant of posterior canal benign paroxysmal positional vertigo.

No MeSH data available.


Related in: MedlinePlus

The mechanism of spontaneous inversion of nystagmus in a patient with left-sided PC-BPPV (dark arrow indicates the direction of the rotation).
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Related In: Results  -  Collection


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fig2: The mechanism of spontaneous inversion of nystagmus in a patient with left-sided PC-BPPV (dark arrow indicates the direction of the rotation).

Mentions: A 38-year-old woman with a medical story of head induced vertigo for less than two weeks was admitted to the outpatient clinic. She had no evident associated problem and could be defined as an “idiopathic” case. A verbal consent and a signed informed consent were obtained from the patient. The procedures were in accordance with the ethical standards of the Declaration of Helsinki and of the institutional review board. Diagnosis of PC-BPPV was based on medical history and the presence of upbeating rotational nystagmus during head-hanging maneuver when the affected ear is down. However, there was no nystagmus on the right side. But, on the left side, counterclockwise, rotational, torsional, and upbeating nystagmus was seen initially which was later followed by clockwise rotational nystagmus while keeping the head at the hanging position which confirmed a left-sided PC-BPPV. The patient was also subjected to head-roll and straight head-hanging maneuvers which were not remarkable. Inversion of the nystagmus was documented when the patient got back to sitting position. Videonystagmography (Micromed, Inc., USA) recording confirmed a new variant of PC-BPPV (video-link) (see Supplementary Material available online at http://dx.doi.org/10.1155/2015/816081). Latency was very brief (5 seconds). First phase of nystagmus appeared immediately after bringing the patient's head to head-hanging position and lasted 15 seconds followed by a “silent phase” for another 10 seconds as seen on video. Then, a second phase of nystagmus appeared lasting for 40 seconds. Whole event happened in 80 seconds. The intensity of the first-phase nystagmus was stronger than that of second phase. Maximal slow phase velocity was calculated as 6 and 3 degrees/sec for the first phase and second phase of nystagmus, respectively. However, the second-phase nystagmus lasted longer. The patient was completely cured after one single Epley maneuver for the left side. Schematic view of rotatory, torsional, and upbeating nystagmus (clockwise) during head-hanging position in patients with a common left-sided PC-BPPV is seen in Figure 1. The mechanism of spontaneous inversion of nystagmus in an atypical PC-BPPV is demonstrated in Figure 2.


A New Variant of Posterior Canal Benign Paroxysmal Positional Vertigo: A Nonampullary or Common Crus Canalolithiasis.

Yetiser S - Case Rep Otolaryngol (2015)

The mechanism of spontaneous inversion of nystagmus in a patient with left-sided PC-BPPV (dark arrow indicates the direction of the rotation).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4465689&req=5

fig2: The mechanism of spontaneous inversion of nystagmus in a patient with left-sided PC-BPPV (dark arrow indicates the direction of the rotation).
Mentions: A 38-year-old woman with a medical story of head induced vertigo for less than two weeks was admitted to the outpatient clinic. She had no evident associated problem and could be defined as an “idiopathic” case. A verbal consent and a signed informed consent were obtained from the patient. The procedures were in accordance with the ethical standards of the Declaration of Helsinki and of the institutional review board. Diagnosis of PC-BPPV was based on medical history and the presence of upbeating rotational nystagmus during head-hanging maneuver when the affected ear is down. However, there was no nystagmus on the right side. But, on the left side, counterclockwise, rotational, torsional, and upbeating nystagmus was seen initially which was later followed by clockwise rotational nystagmus while keeping the head at the hanging position which confirmed a left-sided PC-BPPV. The patient was also subjected to head-roll and straight head-hanging maneuvers which were not remarkable. Inversion of the nystagmus was documented when the patient got back to sitting position. Videonystagmography (Micromed, Inc., USA) recording confirmed a new variant of PC-BPPV (video-link) (see Supplementary Material available online at http://dx.doi.org/10.1155/2015/816081). Latency was very brief (5 seconds). First phase of nystagmus appeared immediately after bringing the patient's head to head-hanging position and lasted 15 seconds followed by a “silent phase” for another 10 seconds as seen on video. Then, a second phase of nystagmus appeared lasting for 40 seconds. Whole event happened in 80 seconds. The intensity of the first-phase nystagmus was stronger than that of second phase. Maximal slow phase velocity was calculated as 6 and 3 degrees/sec for the first phase and second phase of nystagmus, respectively. However, the second-phase nystagmus lasted longer. The patient was completely cured after one single Epley maneuver for the left side. Schematic view of rotatory, torsional, and upbeating nystagmus (clockwise) during head-hanging position in patients with a common left-sided PC-BPPV is seen in Figure 1. The mechanism of spontaneous inversion of nystagmus in an atypical PC-BPPV is demonstrated in Figure 2.

Bottom Line: Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before.We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth.Unexpected rotational direction may lead to confusion about the site.

View Article: PubMed Central - PubMed

Affiliation: Department of ORL, Anadolu Medical Center, 41400 Kocaeli, Turkey.

ABSTRACT
Clockwise or counterclockwise, rotational, upbeating nystagmus is seen in patients with posterior canal benign paroxysmal positional vertigo during left or right head-hanging test, respectively. Rotating of nystagmus in opposite direction to the ear tested or even reversal of initial positioning rotational nystagmus is not usual and has never been reported before. We propose a new variant of posterior canal benign paroxysmal positional vertigo due to unusual behavior and location of the otoliths inside the membranous labyrinth. Unexpected rotational direction may lead to confusion about the site. The examiner should be aware of this abnormal or atypical variant of posterior canal benign paroxysmal positional vertigo.

No MeSH data available.


Related in: MedlinePlus