Characteristics of positional nystagmus in patients with horizontal canal canalolithiasis or cupulopathy

Wang, Hui; Yao, Qinke; Li, Zhuangzhuang; Yu, Dongzhen; Shi, Haibo

doi:10.1007/s00415-019-09435-5

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Subsequently, several studies have reported the characteristics of light cupula (4,(7)(8)(9)(10)(11)(12)(13)(14). Spontaneous nystagmus is more prevalent in light cupula cases than canalolithiasis.…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and lateralization of the horizontal semicircular canal light cupula

Qin,

Liu,

Zhu

et al. 2024

Front. Neurol.

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IntroductionPositional 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.MethodsEighty-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.ResultsLight 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.ConclusionBesides 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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Section: Introductionmentioning

confidence: 99%

Clinical characteristics and lateralization of the horizontal semicircular canal light cupula

Qin,

Liu,

Zhu

et al. 2024

Front. Neurol.

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“…Nystagmus is clinically confirmed by direct observation of the eyes or by recording the eye movements with techniques such as electrooculography, the scleral search coil, video eye-tracking devices or other devices. 1 Many features can be identified to characterize nystagmus 12 , 13 such as: plane of movement (horizontal, vertical, torsional or a combination) 14 ; amplitude of movement; frequency (cycles per grade); waveform (jerk or pendular nystagmus) 8 , 10 ; conjugacy (differences in movements between both eyes); foveation periods (low velocity periods allowing the fovea to receive information) and others. 7 , 14 , 15 Different models, metrics and algorithms (NAF, NAFX 13 and NOFF 16 ) have been proposed to describe and evaluate the mechanisms that produce nystagmus, its dynamics or waveform morphology and the effects of treatment, usually based on standard deviation, gain, frequencies and precision of saccades.…”

Section: Introductionmentioning

confidence: 99%

“… 1 Many features can be identified to characterize nystagmus 12 , 13 such as: plane of movement (horizontal, vertical, torsional or a combination) 14 ; amplitude of movement; frequency (cycles per grade); waveform (jerk or pendular nystagmus) 8 , 10 ; conjugacy (differences in movements between both eyes); foveation periods (low velocity periods allowing the fovea to receive information) and others. 7 , 14 , 15 Different models, metrics and algorithms (NAF, NAFX 13 and NOFF 16 ) have been proposed to describe and evaluate the mechanisms that produce nystagmus, its dynamics or waveform morphology and the effects of treatment, usually based on standard deviation, gain, frequencies and precision of saccades. 12 , 13 , 16 , 17 To our knowledge, these proposals have not been implemented in clinical practice to facilitate the classification or assessment of nystagmus, probably because they require careful and precise calibration 13 , 16 of the eye-tracking device, which is particularly difficult in infantile nystagmus patients.…”

Section: Introductionmentioning

confidence: 99%

A dynamical method to objectively assess infantile nystagmus based on eye tracking. A pilot study

Meo

Punta

Sánchez

et al. 2023

Journal of Optometry

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“…Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, characterized by transient vertigo episodes triggered by head position changes. 1 The most accepted theory for its pathophysiology is the detachment of otoconia from the utricular otolith macula into the semicircular canals (SCC). The horizontal SCC (HSCC) accounts for 5%–30% of all BPPV cases.…”

Section: Introductionmentioning

confidence: 99%

“…The horizontal SCC (HSCC) accounts for 5%–30% of all BPPV cases. 1 , 2 HSCC-BPPV can be confirmed with the supine roll test (SRT), where a paroxystic positional nystagmus beating in the plane of the affected canal is evoked, with latency, fatigability, and generally lasting less than 1 min. 3 When free otoliths or debris are suspended in the HSCC (canalithiasis), a geotropic or undermost ear direction changing positional nystagmus (DCPN) is observed.…”

Section: Introductionmentioning

confidence: 99%

Conversion from geotropic to apogeotropic direction changing positional nystagmus resulting in heavy cupula positional vertigo: case report

Lagos

Ramos

Aracena-Carmona

et al. 2021

Brazilian Journal of Otorhinolaryngology

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Characteristics of positional nystagmus in patients with horizontal canal canalolithiasis or cupulopathy

Cited by 7 publications

References 17 publications

Clinical characteristics and lateralization of the horizontal semicircular canal light cupula

Clinical characteristics and lateralization of the horizontal semicircular canal light cupula

A dynamical method to objectively assess infantile nystagmus based on eye tracking. A pilot study

Conversion from geotropic to apogeotropic direction changing positional nystagmus resulting in heavy cupula positional vertigo: case report

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