Less talked variants of benign paroxysmal positional vertigo

Kim, Jae‐Myung; Lee, Seung-Han; Kim, Hyojung; Kim, Ji-Soo

doi:10.1016/j.jns.2022.120440

Cited by 10 publications

(7 citation statements)

References 57 publications

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“…1A ). 5 In cupulolithiasis, positional nystagmus is known to usually occur without any latency, as in our patient during the half Dix-Hallpike maneuver. However, the same pattern of nystagmus developed with a marked latency of about 15 seconds during the initial lying down.…”

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confidence: 52%

“… 1 2 3 In contrast, the otoconia located in the short arm (utricular side) of the PC usually do not trigger nystagmus during the Dix-Hallpike maneuver, instead inducing vertigo/body sway with or without nystagmus upon resuming a sitting position after the maneuver. 4 5 In cupulolithiasis involving the PC, positional vertigo and nystagmus might not occur during the conventional Dix-Hallpike maneuver. Instead, upbeat and ipsiversive torsional beating nystagmus are better evoked by the so-called half Dix-Hallpike maneuver.…”

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confidence: 99%

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Atypical Benign Paroxysmal Positional Vertigo: Concomitant Cupulolithiasis and Short-Arm Canalolithiasis Involving the Posterior Canal?

Kim,

Gil

et al. 2024

J Clin Neurol

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confidence: 52%

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confidence: 99%

Atypical Benign Paroxysmal Positional Vertigo: Concomitant Cupulolithiasis and Short-Arm Canalolithiasis Involving the Posterior Canal?

Kim,

Gil

et al. 2024

J Clin Neurol

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“…Of interest, one patient presented with a triggered episodic vestibular syndrome (tEVS), with vertigo being evoked by positional changes, resembling rather benign paroxysmal positional vertigo (BPPV) than vestibular neuritis. This patient (case 6) showed apogeotropic positional nystagmus mimicking horizontal canal BPPV with cupulolithiasis or short-arm canalolithiasis ( 29 , 30 ). However, the patient did not improve after repetitive canalith repositioning maneuvers and she had abnormal pursuit eye movements.…”

Section: Discussionmentioning

confidence: 94%

Video head impulse testing in patients with isolated (hemi)nodular infarction

Lee

Kim²,

Kim³

et al. 2023

Front. Neurol.

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BackgroundIsolated (hemi)nodular strokes as underlying cause of acute dizziness are rare, thus there are still gaps of knowledge in the clinical presentation of affected patients. Clinical and experimental evidence has suggested that lesions involving the nodulus lead to various vestibulo-ocular deficits including prolonged velocity-storage, periodic-alternating nystagmus, positional nystagmus, abolished suppression of post-rotatory nystagmus by head-tilt and impaired verticality perception. At the bedside, the angular vestibulo-ocular reflex (aVOR), as assessed by the horizontal head-impulse test (HIT), has been reported to be normal, however quantitative assessments of all six semicircular canals are lacking.ObjectiveThe primary aim of this case series was to characterize the spectrum of clinical presentations in isolated (hemi)nodular strokes. Furthermore, based on preliminary observations, we hypothesized that the aVOR is within normal limits in isolated nodular strokes.MethodsWe retrospectively included patients with isolated (hemi)nodular stroke on diffusion-weighted MR-imaging from a prospective stroke-registry. All patients received a standardized bedside neuro-otological assessment and quantitative, video-based HIT (vHIT) of all six semicircular canals. Overall ratings of vHIT (normal vs. abnormal function) were performed independently by two reviewers and disagreements were resolved.ResultsBetween January 2015 and December 2021 six patients with isolated nodular (n = 1) or heminodular (n = 5) ischemic stroke were included. Clinical presentation met diagnostic criteria for acute vestibular syndrome (AVS) in 5/6 patients and for episodic vestibular syndrome (EVS) in 1/6 patients. Ocular motor abnormalities observed included the presence of spontaneous horizontal nystagmus (n = 2), positional nystagmus (5/6), head-shaking nystagmus (3/6), skew deviation (n = 1), and moderate or severe truncal ataxia (5/6). Bedside HIT was normal in all patients and no gaze-evoked or periodic alternating nystagmus was observed. aVOR-gains were within normal range in all patients and overall aVOR-function as assessed by vHIT was rated as normal in all six patients.ConclusionsUsing quantitative, video-based testing of the horizontal and vertical aVOR, preserved integrity of the aVOR in (hemi)nodular strokes was confirmed, extending preliminary findings at the bedside. Furthermore, widespread deficits of both ocular stability, postural control and volitional eye movements were observed in our study cohort, being consistent with findings reported in previous studies.

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“…Relating to peripheral vestibular BPPV pathology, we find that the current literature [ 26 ] describes emerging and controversial syndromes of BPPV, atypical nystagmus according to the canal involved and persistent geotropic positional nystagmus. The study of these peculiarities allows us to better understand the pathomechanisms of BPPV and to differentiate it from central disorders that cause vertigo and nystagmus.…”

Section: Discussionmentioning

confidence: 99%

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

et al. 2023

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Background: Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. Methods: Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). Results: We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. Discussion: There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. Conclusion: A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.

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Less talked variants of benign paroxysmal positional vertigo

Cited by 10 publications

References 57 publications

Atypical Benign Paroxysmal Positional Vertigo: Concomitant Cupulolithiasis and Short-Arm Canalolithiasis Involving the Posterior Canal?

Atypical Benign Paroxysmal Positional Vertigo: Concomitant Cupulolithiasis and Short-Arm Canalolithiasis Involving the Posterior Canal?

Video head impulse testing in patients with isolated (hemi)nodular infarction

Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis

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