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Qin W, Liu Z, Zhu Y, Zhang X, Xu J, Zhou T, Wei L, Fang Y, Chang L. Clinical characteristics and lateralization of the horizontal semicircular canal light cupula. Front Neurol 2024; 15:1357195. [PMID: 38450079 PMCID: PMC10914934 DOI: 10.3389/fneur.2024.1357195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Positional vertigo and nystagmus are the main symptoms and signs of dizziness, respectively. Despite the clinical utility of the supine roll test (SRT) and null point (NP) in diagnosing light cupula, a type of positional vertigo, there exists a notable gap in the literature concerning the comprehensive evaluation of lateralization values based on various nystagmus characteristics and the intensity of direction-changing positional nystagmus (DCPN) in the SRT, particularly in comparison to the NP. Additionally, limited data on abnormal canal paresis (CP) in light cupula patients underscores the need for further research with a larger patient population to elucidate this mechanism. This study aims to investigate the characteristics of positional nystagmus and lateralization of the horizontal semicircular canal (HSCC) light cupula, which is a type of positional vertigo and nystagmus that is poorly understood. Methods Eighty-five patients (17 males, 68 females; mean age, 60.9 years) with light cupula were reviewed. We summarized the characteristics of spontaneous nystagmus and positional nystagmus, including supine positioning nystagmus, bow nystagmus, and lean nystagmus. Then, the side of the NP was identified as the affected side, and the values of the fast phase direction of the spontaneous nystagmus, supine positioning nystagmus, bow nystagmus, and lean nystagmus, as well as the intensity of the DCPN in the SRT, were used to diagnose the affected sides. Caloric testing was also performed for some patients. Results Light cupula was observed in 5.7% of the patients with positional nystagmus. The frequencies of supine positioning nystagmus (88.2%), bow nystagmus (90.6%), and lean nystagmus (83.5%) were higher than spontaneous nystagmus (61.2%) (p < 0.001). The second NP (NP2) (92.9%) and third NP (NP3) (83.5%) were readily detected, affecting the left and right sides in 38 and 47 patients, respectively. Lateralization through the fast phase directions of bow nystagmus and lean nystagmus did not significantly differ from that of NP (all p > 0.05). However, the accuracy rate of lateralization through the sides with more vigorous DCPN in the SRT was 63.5%, significantly lower than through NP (p < 0.001). Particularly in patients with supine positioning nystagmus (n = 75), the rate was only 58.7% (p < 0.001). However, the rate was 100% in patients without supine positioning nystagmus (n = 10). Among the 70 patients who underwent caloric testing, 37 had abnormal CP, and the sides of the reduced caloric reaction were ipsilateral to the affected sides of the light cupula in 83.8% of the patients. Conclusion Besides utilizing the NP to determine the affected side, the fast phase direction of the bow nystagmus or lean nystagmus can also aid in identification. However, a simple comparison of the intensity of DCPN in SRT cannot provide accurate lateralization, especially in patients with supine positioning nystagmus. There is a high incidence of CP on the affected side of the light cupula.
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Affiliation(s)
| | | | | | | | | | | | | | - Yi Fang
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Liying Chang
- Department of Neurology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
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Peng H, Wang L, Song H, Gao B, Yang Y, Lyu F. Clinical Characteristics of persistent geotropic horizontal direction-changing positional nystagmus: Experience in 189 participants. J Vestib Res 2023; 33:203-211. [PMID: 36776085 DOI: 10.3233/ves-220086] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial. OBJECTIVE The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal. METHODS The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic horizontal DCPN participants. RESULTS The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history. CONCLUSION Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV.
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Affiliation(s)
- Hao Peng
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Liyi Wang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Haitao Song
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Bo Gao
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Yi Yang
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
| | - Fan Lyu
- Department of Otolaryngology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, China
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Bal N, Altun M, Kuru E, Basoz Behmen M, Gedik Toker O. Light cupula phenomenon: a systematic review. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00336-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractGeotropic direction-changing positional nystagmus (DCPN) is transient in lateral semicircular canal (LSSK) canalolithiasis; it usually cuts off within a minute and fatigues. However, a “light cupula” mechanism has been described for patients with positional vertigo who exhibit a persistent geotropic DCPN without delay or fatigue. When the cupula becomes lighter than the surrounding endolymph, deflection may occur in the cupula under the influence of gravity. The person experiences dizziness and persistent positional nystagmus can be observed while remaining in that position.In this review, studies investigating the “light cupula phenomenon,” which is a newly defined phenomenon in the literature, were compiled. A systematic literature search was conducted on the light cupula phenomenon in PubMed and Google Scholar databases to illuminate the clinical side of this new phenomenon and reveal its distinctive features. Turkish and English articles published between 2010 and 2021 were scanned; the thesis, reviews, and books were excluded from the study. Forty-eight articles were included in the study.Mechanisms underlying light cupula has been explained as the “heavier endolymph hypothesis” with increased endolymph specific gravity due to an acute attack such as labyrinth hemorrhage, insufficient inner ear perfusion, or inflammation in the inner ear; “lighter cupula hypothesis” based on alcohol acting on the cupula earlier and making it lighter than the endolymph; “light particle hypothesis” due to the buoyancy of light debris, which are degenerative, swollen, and inflammatory cells in the endolymph adhering to the cupula and the “altered endolymph/perilymph density ratio hypothesis” that the difference in density between perilymph and endolymph causes light cupula. The pathophysiology of the light cupula phenomenon is still unclear, but it can be thought that all the different hypotheses may be effective in this phenomenon. Therefore, nystagmus characteristics and clinical course should be considered in patients for a more effective diagnosis and treatment process. In addition, the results of the studies show that light cupula may not be an uncommon disease and that some patients with geotropic DCPN can often be misdiagnosed as canalolithiasis LSCC-BPPV.
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Wang Z, Zhang Y, Guo Q, Lin Y, Li JJ. Analysis of the nystagmus characteristics of cupula diseases: A case report. Medicine (Baltimore) 2022; 101:e28211. [PMID: 35029875 PMCID: PMC8735787 DOI: 10.1097/md.0000000000028211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Clinically, there is a kind of patients with positional vertigo or dizziness, which occurs when they turn left or right, look down or up, lie down or sit up. With a long duration and varying frequency, it is not consistent with the manifestations of benign paroxysmal positional vertigo (BPPV). In addition, the persistent geotropic direction-changing positional nystagmus (PG-DCPN) was observed in a supine head-roll test. PATIENT CONCERNS With no apparent trigger for visual rotation and a sense of self instability, an 81-year-old female patient had suffered from vertigo for 3 days. The vertigo occurred every day, lasting several minutes each time, and associated with head movements and changes in body position. In a supine head-roll test, it appeared persistent geotropic direction-changing positional nystagmus for a long time, without latency, fatigability and in the presence of 3 zero planes. DIAGNOSIS Light cupula. INTERVENTIONS Difenidol hydrochloride 25 mg orally 3 times/day for 2 weeks and betahistine hydrochloride 12 mg orally 3 times/day for 1 month were administered. OUTCOMES After 1 month of treatment, the patient's vertigo symptoms disappeared. And in the supine head-roll test, the persistent geotropic direction-changing positional nystagmus disappeared. CONCLUSION We report the characteristics of nystagmus produced in a typical patient with light cupula during the supine head-roll test. After reviewing the relevant literatures, we believe that a simpler method can be used to identify canalolithiasis and cupula disease, to distinguish light and heavy cupula, and to determine the pathological semicircular canal to which the lesion belongs.
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Affiliation(s)
- Zhaoxia Wang
- Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T. Shenzhen, China
| | - Yang Zhang
- Aerospace Balance Medical Center, Chinese PLA Air Force Medical Center, Beijing, China
| | - Qiang Guo
- Department of Otolaryngology & Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, PR China
| | - Ying Lin
- Department of Otolaryngology & Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, PR China
| | - Juan-Juan Li
- Department of Otolaryngology, Longgang E.N.T. Hospital & Shenzhen Key Laboratory of E.N.T., Institute of E.N.T. Shenzhen, China
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Yetiser S, Ince D. An analysis of correlation between persistent positional nystagmus and treatment outcome in patients with lateral canal benign paroxysmal positional vertigo. J Otol 2022; 17:90-94. [PMID: 35949550 PMCID: PMC9349017 DOI: 10.1016/j.joto.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Material and method Results Conclusion
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Affiliation(s)
- Sertac Yetiser
- Corresponding author. Anadolu Medical Center, Dept of ORL & HNS, Gebze, 41400, Kocaeli, Turkey.
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Zhang SL, Tian E, Xu WC, Zhu YT, Kong WJ. Light Cupula: To Be Or Not to Be? Curr Med Sci 2020; 40:455-462. [PMID: 32681250 DOI: 10.1007/s11596-020-2199-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/09/2020] [Indexed: 01/09/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) represents the most common form of positional vertigo. It is caused by dislodged otoconia that freely float in the semicircular canals (canalolithiasis) or attach to the cupula (cupulolithiasis). A cupulolithiasis-type (or a heavy cupula-type) of BPPV implicating the lateral semicircular canal (LSCC) exhibits persistent ageotropic direction-changing positional nystagmus (DCPN) in a head-roll test. However, in some cases, unlike any type of BPPV, persistent geotropic DCPN cannot be explained by any mechanisms of BPPV, and don't fit the current classifications. Recently, the notion of light cupula has been introduced to refer to the persistent geotropic DCPN. In this study, we looked at the clinical features of light cuplula and discussed the possible mechanisms and therapeutic strategies of the condition. The notion of light cupula is a helpful addition to the theory of peripheral positional vertigo and nystagmus.
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Affiliation(s)
- Su-Lin Zhang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - E Tian
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wen-Chao Xu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu-Ting Zhu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei-Jia Kong
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Institute of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. .,Key Laboratory of Neurological Disorders of Education Ministry, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Kim SK, Li SW, Hong SM. Differences in the Head Roll Test, Bow and Lean Test, and Null Plane between Persistent and Transient Geotropic Direction-Changing Positional Nystagmus. J Clin Med 2019; 9:E73. [PMID: 31892175 PMCID: PMC7019752 DOI: 10.3390/jcm9010073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Persistent geotropic direction-changing positional nystagmus (DCPN) has the characteristics of cupulopathy, but its underlying pathogenesis is not known. We investigated the relationship of the results of the head roll test, bow and lean test, and side of the null plane between persistent and transient geotropic DCPN to determine the lesion side of persistent geotropic DCPN and understand its mechanism. METHODS We enrolled 25 patients with persistent geotropic DCPN and 41 with transient geotropic DCPN. We compared the results of the head roll test, bow and lean test, and side of the null plane between the two groups. RESULTS The rates of bowing and leaning nystagmus were significantly higher in the persistent DCPN group. Only 16.0% of the persistent DCPN patients had stronger nystagmus in the head roll test and the null plane on the same side. The rates of the direction of bowing nystagmus in the bow and lean test and stronger nystagmus in the head roll test on the same side were also significantly lower in persistent DCPN than in transient DCPN. CONCLUSION It was difficult to determine the lesion side in persistent geotropic DCPN using the direction of stronger nystagmus in the head roll test and null plane when the direction of the stronger nystagmus and null plane were opposite. Further study is needed to understand the position of the cupula according to head rotation and the anatomical position in persistent geotropic DCPN.
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Affiliation(s)
| | | | - Seok Min Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, #7 Keunjaebong-gil, Gyeonggi-do, Hwaseong 18450, Korea; (S.K.K.); (S.W.L.)
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Characteristics of positional nystagmus in patients with horizontal canal canalolithiasis or cupulopathy. J Neurol 2019; 266:2475-2480. [DOI: 10.1007/s00415-019-09435-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
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Kim CH, Pham NC. Density difference between perilymph and endolymph: A new hypothesis for light cupula phenomenon. Med Hypotheses 2019; 123:55-59. [PMID: 30696592 DOI: 10.1016/j.mehy.2018.12.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
Light cupula is an emerging concept accounting for positional nystagmus. It can be diagnosed when persistent geotropic direction-changing positional nystagmus (PG DCPN) is observed in a head-roll test. Although hypotheses explaining light cupula phenomenon such as "light debris", "lighter cupula", and "heavier endolymph" have been proposed, the mechanism underlying light cupula has not been clearly elucidated yet. In the present study, we proposed a new hypothesis accounting for light cupula, i.e., density difference between perilymph and endolymph could elicit characteristic PG DCPN in a head-roll test. We also discussed the mechanism how membranous canal containing endolymph became buoyant within the perilymphatic space under constant influence of gravity when the density of perilymph was higher than that of endolymph.
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Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
| | - Ngoc Chien Pham
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Shi T, Yu L, Yang Y, Wang Y, Shao Y, Wang M, Geng Y, Shi Z, Yin X. The effective clinical outcomes of the Gufoni maneuver used to treat 91 vertigo patients with apogeotropic direction-changing positional nystagmus (apo-DCPN). Medicine (Baltimore) 2018; 97:e12363. [PMID: 30278514 PMCID: PMC6181626 DOI: 10.1097/md.0000000000012363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study aimed to observe and analyze the effects and outcomes of patients with apogeotropic direction-changing positional nystagmus (apo-DCPN) who received Gufoni maneuver.A total of 91 patients with positional vertigo admitted to the specialized dizziness clinic in Zhejiang Provincial People's Hospital from February 2014 to August 2017 were included. The immediate treatment responses to the Gufoni maneuver were observed and recorded. The patients in whom the treatment was ineffective were followed up for 4 weeks to observe the outcome of apo-DCPN.In 21 patients, the apo-DCPN was transformed after Gufoni maneuver, and 7 patients developed transformation within 4 weeks of follow-up. Spontaneous remission of apo-DCPN within the follow-up period was observed in 55 patients who were unresponsive to the Gufoni maneuver. The prevalence of migraine was significantly higher in the early remission group (P < .05) and the period between the initial visit and nystagmus remission was significantly shorter in the group of patients with migraine history (P < .05).This study demonstrates that the immediate treatment efficacy of the Gufoni maneuver is poor in positional vertigo patients with apo-DCPN. We believe that the reason for the low efficacy is that the Gufoni maneuver is only effective for some patients with apo-DCPN type HSC-BPPV. In patients with early spontaneous remission and a history of migraine, central positional nystagmus of probable vestibular migraine (VM) or benign recurrent vertigo should be considered for the mechanisms of apo-DCPN generation.
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Affiliation(s)
- Tianming Shi
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Lihua Yu
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Yi Yang
- Department of Neurology, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, China
| | - Yiqi Wang
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Yanqi Shao
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Meiping Wang
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Yu Geng
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Zongjie Shi
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
| | - Xiaojun Yin
- Department of Neurology, Zhejiang Provincial People's Hospital
- People's Hospital of Hangzhou Medical College
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Ichijo H. Affected-ear-up 120° maneuver for treatment of lateral semicircular canal benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2017; 274:3351-3357. [PMID: 28685312 DOI: 10.1007/s00405-017-4663-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
Abstract
Although several researchers have tried various canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We adopt 120° rotation, which is anatomically appropriate because the principle of cure may be the fixing of pathological debris to the dark cells of the utricle. The aims of this study were to clarify the efficacy rate of the affected-ear-up 120° maneuver and to elucidate the appearance rate of lying-down nystagmus in patients with lateral canalolithiasis. The subjects were 31 patients (26 females, 5 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the involved side, we performed the canalith repositioning procedure immediately. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until facing downward 120° from supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed. Twenty-nine patients (94%) became symptom free by only one maneuver. However, one patient converted to ipsilateral posterior cupulolithiasis, and another required a second maneuver. Lying-down nystagmus was found in 29 patients (94%), the transient type in 23 (74%), and the persistent type in 6 (19%). The direction of transient (not persistent) lying-down nystagmus was mostly toward the healthy side. These results suggest that the affected-ear-up 120° maneuver is effective and that lying-down nystagmus appears at a high rate.
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Affiliation(s)
- Hiroaki Ichijo
- Ichijo Ear, Nose and Throat Clinic, 3-2-1, Ekimae, Hirosaki, 036-8002, Japan.
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Welgampola MS, Akdal G, Halmagyi GM. Neuro-otology- some recent clinical advances. J Neurol 2016; 264:188-203. [PMID: 27632181 PMCID: PMC5225204 DOI: 10.1007/s00415-016-8266-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
Vestibular disorders manifesting as vertigo, chronic dizziness and imbalance are common problems in neurological practice. Here, we review some recent interesting and important advances in diagnosis of vestibular disorders using the video head impulse test and in the management of benign positional vertigo and migrainous vertigo.
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Affiliation(s)
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
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Cha WW, Song K, Lee HY. Persistent Geotropic Direction-Changing Positional Nystagmus Treated With Transcutaneous Vagus Nerve Stimulation. Brain Stimul 2016; 9:469-470. [DOI: 10.1016/j.brs.2016.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022] Open
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