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

Lagos, Antonia; Ramos, Phoebe Helena; Aracena-Carmona, Karina; Novoa, Iván

doi:10.1016/j.bjorl.2020.10.016

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Hiruma et al hypothesized that a heavy cupula would actually be more of an otoconial phenomenon than a gravitational change and set forth the possibility of a phenomenon in which particles float (“buoyancy”) in the horizontal canal, contrary to what happens in a light cupula, in which there would be an increase of endolymphatic density. In their 2011 paper, they mentioned that patients with a heavy cupula diagnosis responded to repositioning maneuvers, while light cupula patients did not [ 23 , 24 ].…”

Section: Cupula-endolymph Density Alterationmentioning

confidence: 99%

Atypical Positional Vertigo: Definition, Causes, and Mechanisms

Carmona

Zalazar²,

Fernández³

et al. 2022

Audiology Research

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Paroxysmal positional vertigo is a frequent cause for consultation. When approaching these patients, we try to differentiate central from peripheral causes, but sometimes we find manifestations that generate diagnostic doubts. In this review, we address atypical paroxysmal positional vertigo, reviewing the literature on the subject and giving a provisional definition of atypical positional vertigo as well as outlining its causes and pathophysiological mechanisms.

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Section: Cupula-endolymph Density Alterationmentioning

confidence: 99%

Atypical Positional Vertigo: Definition, Causes, and Mechanisms

Carmona

Zalazar²,

Fernández³

et al. 2022

Audiology Research

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Light cupula phenomenon: a systematic review

Bal

Altun

Kuru

et al. 2022

Egypt J Otolaryngol

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

Cited by 2 publications

References 10 publications

Atypical Positional Vertigo: Definition, Causes, and Mechanisms

Atypical Positional Vertigo: Definition, Causes, and Mechanisms

Light cupula phenomenon: a systematic review

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