Positional vertigo and the cerebellar vermis

Kattah, Jorge C.; Kolsky, Martin P.; Luessenhop, Alfred J.

doi:10.1212/wnl.34.4.527

Cited by 51 publications

(32 citation statements)

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“…CPN was purely vertical in 19 of the 40 (47.5%) patients (7,14,16,19,27,30), purely horizontal in 5 (12.5%) (7,18,34), purely torsional (rotatory) in 2 (5%) (12,34), and was a combination involving a downbeating component in 13 (32.5%) (7,17,30). Of the 40 (48.8%) participants with positive D-H, only 1 demonstrated nystagmus in the direction considered "typical" of BPPV (31).…”

Section: Dix-hallpikementioning

confidence: 99%

“…The purely vertical nystagmus upon D-H was pure downbeating in 17 (42.5%) (7,14,16,27,30), pure upbeating in 1 (2.5%) (19), and upbeating followed by downbeating in 1 (2.5%) (7). Due to a lack of consensus in terminology, it was impossible to interpret the direction of torsional nystagmus unless specified, but nystagmus beating away from the lowermost ear (apogeotropic) was reported by Choi et al (4) in all nine of the patients who were presented with torsional nystagmus upon D-H testing (4).…”

Section: Dix-hallpikementioning

confidence: 99%

“…Included studies ranged in (relevant) sample sizes from single case subjects (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) up to 14 subjects (26)(27)(28)(29).…”

Section: Participantsmentioning

confidence: 99%

“…In 33 (40.2%) cases, D-H alone was used to trigger CPN (7,11,12,14,17,19,25,27,31,34). CPN was triggered only upon lying supine with either ear down in 26 (31.7%) cases (6, 7, 13, 15, 20-24, 26, 28, 32-35) and only upon SHH in 3 (3.7%) (6,31,33).…”

Section: Interventionmentioning

confidence: 99%

“…The study set included 11 case series (6,7,11,26,(30)(31)(32)(33)(34)(35)(36) and 17 case reports (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(27)(28)(29). This review did not identify any controlled studies relevant to the diagnosis of central positional vertigo/nystagmus.…”

Section: Study Designsmentioning

confidence: 99%

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Central Positional Nystagmus: A Systematic Literature Review

Kaski

Macdonald

Saman³

et al. 2016

J Neurol Neurosurg Psychiatry

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Objective: To provide a systematic review of the clinical and radiological features of lesion-induced central positional nystagmus (CPN) and identify salient characteristics that differentiate central from peripheral positional nystagmus (PN).Methods: Systematic literature search according to the preferred reporting items for systematic reviews and meta-analysis.Results: A total of 82 patients from 28 studies met the participants intervention, comparison, outcomes, and study designs criteria for inclusion. An atypical direction of nystagmus for the stimulated canal was reported in 97.5% patients during Dix-Hallpike (D-H) and 54.5% upon supine roll testing. Five types of CPNs were identified during positional testing: positional horizontal nystagmus (pHN) (36.8%), positional downbeating nystagmus (pDBN) (29.2%), positional torsional nystagmus (pTN) (2.1%), positional upbeating nystagmus (pUBN) (2.1%), and a combination of the four profiles (29.9%). CPN was paroxysmal (<60 s) in 85% patients on straight head hanging (SHH), 63.9% on D-H, and 37.5% on supine roll, and had a latency <3 s upon positioning in 94.7% patients in which it was reported. Concurrent vertigo was reportedly present in 63.4% patients and 48.8% demonstrated other neurological signs. Radiologically, in 74.4%, there was mention of cerebellar involvement, isolated brainstem involvement in 8.5%, and 14.6% involved the fourth ventricle. Conclusion:Currently, there is a lack of robust data on the clinical and radiological characteristics of CPN highlighting the need for better phenotyping of CPN to help differentiate this entity from peripheral causes of PN. With increased awareness of CPN, particularly in the acute setting, we may see a change in the estimated prevalence of CPN and improved clinical markers to promptly identify the frequently sinister underlying causes.

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Section: Dix-hallpikementioning

confidence: 99%

Section: Dix-hallpikementioning

confidence: 99%

“…Included studies ranged in (relevant) sample sizes from single case subjects (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) up to 14 subjects (26)(27)(28)(29).…”

Section: Participantsmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Study Designsmentioning

confidence: 99%

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Central Positional Nystagmus: A Systematic Literature Review

Kaski

Macdonald

Saman³

et al. 2016

J Neurol Neurosurg Psychiatry

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Isolated horizontal positional nystagmus from a posterior fossa lesion

Lee¹,

Kim

et al. 2014

Annals of Neurology

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Isolated vertigo with horizontal positional nystagmus as an impending sign of a central lesion has rarely been reported. Here we present neuro-otologic findings of patients with these clinical signs. Lesion overlays from 6 patients with ageotropic positional nystagmus revealed that the nodulus and vermis are common areas of injury. In contrast, 2 patients with geotropic positional nystagmus had cerebellar peduncle and lateral medullary lesions. These clinical findings suggest that vertigo with horizontal positional nystagmus, even in the absence of other initial neurological signs, may indicate a posterior fossa lesion, including that in the nodulus, vermis, and deep cerebellar structures.

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Central positional vertigo

Brandt¹

1999

Vertigo

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Positional vertigo and the cerebellar vermis

Abstract: A patient with lower and posterior vermis hematoma presented with truncal ataxia; paroxysmal, positional, downbeating nystagmus; and saccade dysmetria. Drainage of the hematoma resulted in complete resolution of all signs and symptoms.

Cited by 51 publications

References 0 publications

Central Positional Nystagmus: A Systematic Literature Review

Central Positional Nystagmus: A Systematic Literature Review

Isolated horizontal positional nystagmus from a posterior fossa lesion

Central positional vertigo

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