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

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.

Benign Paroxysmal Positional Vertigo – A Review of 101 Cases

“…Thus, the patient's head movement causes these fragments to move and thus an inadequate stimulation of the canal cupula, generating vertigo symptoms. 3,6,8,11,12 Posterior canal involvement is characterized by rotatory and upbeat vertical positional nystagmus (counterclockwise in right labyrinth lesions and clockwise in left labyrinth lesions). 1,3,4,6 This is the most common type of BPPV accounting for up to 90% of the patients.…”

“…3,6,8,11,12 Posterior canal involvement is characterized by rotatory and upbeat vertical positional nystagmus (counterclockwise in right labyrinth lesions and clockwise in left labyrinth lesions). 1,3,4,6 This is the most common type of BPPV accounting for up to 90% of the patients. 3,4,7,12 Anterior canal BPPV is quite rare and its incidence has been reported to range from 1%---2% to 15%.…”

“…1,3,4,6 This is the most common type of BPPV accounting for up to 90% of the patients. 3,4,7,12 Anterior canal BPPV is quite rare and its incidence has been reported to range from 1%---2% to 15%. Anterior canal involvement is characterized by rotatory and downbeat vertical positional nystagmus (counterclockwise in right labyrinth lesions and clockwise in left labyrinth lesions).…”

“…12 Its frequency has been occasionally reported up to 30%. 3 The main BPPV diagnostic maneuver for the posterior canal is the Dix Hallpike test, which aims at triggering the labyrinth symptom or sign such as vertigo, nausea and/or nystagmus. 5,8,11 Anterior canal BPPV produces bilaterally positive Dix Hallpike maneuvers.…”

“…5,8,11 Anterior canal BPPV produces bilaterally positive Dix Hallpike maneuvers. 3 The Dix Hallpike provoking maneuver is used to diagnose the disease by moving the patient rapidly from a sitting position to a position of head hanging with each ear alternately undermost. 3---5,12 This maneuver produces intense vertigo in conjunction with nystagmus, with a short latency, intensity characterized by crescendo and decrescendo element, reversal on returning to the upright position, and fatigability on repetitive provocation may easily establish the diagnosis of BPPV.…”