Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo

Ogawa, Yasuo; Ichimura, Akihide; Otsuka, Koji; Hagiwara, Akira; Inagaki, Taro; Shimizu, Shigetaka; Nagai, Noriko; Itani, Shigeto; Suzuki, Mamoru

doi:10.3233/ves-150552

Cited by 9 publications

(10 citation statements)

References 12 publications

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“…For the explanation of SRPN in BPPV, several hypotheses have been previously proposed, which included the elastic force of cupula or the gravitational forces of otoconia debris, coexistence of cupulolithiasis, and short-term adaptation of VOR (4,7,(9)(10)(11)14). In our study, given long duration of the reversed phase of positional nystagmus, no significant correlation between nystagmus intensities in the first and reversed phases, and immediate disappearance of reversed nystagmus after treatment of canalolithiasis in most patients, the SRPN in BPPV may be ascribed to short-term central adaptation rather than peripheral mechanical forces or coexistence of cupulolithiasis.…”

Section: Discussionmentioning

confidence: 99%

“…(A) After head turning to the right, 3D-video oculography shows vigorous right-beating nystagmus with maximal slow phase velocities of about 140 • /s which decays during 20 s, and then is followed by small left-beating nystagmus lasting more than 60 s. (B) Right Dix-Hallpike maneuver induces upbeat nystagmus with maxSPVs of 50 • /s and rapidly decays during 15 s. Small downbeat nystagmus immediately follows and lasts for 25 s. LH, Horizontal position of the left eye; LV, Vertical position of the left eye. (4,(7)(8)(9)(10)(11). A few studies have described high frequency (73%) of SRPN in HC-BPPV canalolithiasis, whereas the frequency was significantly low (4%) in PC-BPPV (11).…”

Section: Introductionmentioning

confidence: 98%

“…They also reported clinical significance of SRPN that patients presenting with SRPN had a trend to require more repositioning maneuver sessions (11). A spontaneous reflux of endolymph with the elastic force of cupula or the gravitational forces of otoconia debris, coexistence of canalo-and cupulolithiasis, and short-term adaptation of the vestibulo-ocular reflex (VOR) are proposed mechanisms for the development of SRPN in BPPV (4,(7)(8)(9)(10)(11). To date, there have been no prospective studies that investigated the frequency, underlying mechanisms, and clinical implications of SRPN in BPPV.…”

Section: Introductionmentioning

confidence: 99%

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Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Choi

Lee

et al. 2020

Front. Neurol.

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Objective: To elucidate the frequency, underlying mechanisms, and clinical implications of spontaneous reversal of positional nystagmus (SRPN) in benign paroxysmal positional vertigo (BPPV). Methods: We prospectively recruited 182 patients with posterior canal (PC, n = 119) and horizontal canal (HC) BPPV (n = 63) canalolithiasis. We analyzed the maximal slow phase velocity (maxSPV), duration, and time constant (Tc) of positional nystagmus, and compared the measures between groups with and without SRPN. We also compared the treatment outcome between two groups. Results: The frequency of SRPN in PC-and HC-BPPV was 47 and 68%, respectively. The maxSPVs were greater in BPPV with SRPN than without, larger in HC-BPPV than PC-BPPV (114.3 ± 56.8 vs. 57.1 ± 38.1 • /s, p < 0.001). The reversed nystagmus last longer in HC-BPPV than PC-BPPV. The Tc of positional nystagmus got shorter in PC-BPPV with SRPN (3.7 ± 1.8 s) than without SRPN (4.5 ± 2.0 s, p = 0.034), while it was longer during contralesional head turning in HC-BPPV with SRPN (14.8 ± 7.5 s) than that of ipsilesional side (7.3 ±2.8 s, p < 0.001). The treatment response did not significantly differ between groups with and without SRPN in both PC-and HC-BPPV (p = 0.378 and p = 0.737, respectively). Conclusion: The SRPN is common in both PC-and HC-BPPV canalolithiasis. The intensity of rotational stimuli may be a major determinant for the development of short-term central adaptation which utilizes the velocity-storage system below a certain velocity limit. The presence of SRPN is not related to treatment outcome in BPPV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Choi

Lee

et al. 2020

Front. Neurol.

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“…Besides, it has been reported in bilateral cases that reversed nystagmus seen during head turning to healthy side is usually less intense [8,9]. Ogawa, et al [11] reported seven cases (five bilateral and two ipsilateral) with reversal of nystagmus and proposed the possibility of coexistence of canalolithiasis and cupulolithiasis to explain the pathological mechanism for bilateral and unilateral cases. They have indicated that the debris circulating in the long arm of pathological horizontal canal and at the same time, debris entering the non-ampullary side and sinking to the cupula will cause bilateral or unilateral occurrence of reversing nystagmus.…”

Section: Discussionmentioning

confidence: 99%

“…The procedures were in accordance with the ethical standards of the declaration of Helsinki and of institutional review board of the Anadolu Medical Center. Table 1 shows detail analysis of previous nine studies in chronological order [4][5][6][7][8][9][10][11][12].…”

Section: Methodsmentioning

confidence: 99%

Spontaneous Direction-Changing or Reversing Positional Nystagmus without Changing Head Position during Head-Roll/Head-Hanging Maneuvers: Biphasic Positional Nystagmus

Yetışer

2021

J Audiol Otol

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Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases.Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented.Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short “silent phase”. Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver.Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

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An Unusual Phenomenon of Spontaneously Reversing Nystagmus in Peripheral Vertigo—A Case Report and Literature Review

Yeap,

Chan,

Yip

et al. 2024

The Laryngoscope

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Direction‐changing nystagmus on positional testing is classically ascribed to a central pathology. We herein report a case of a patient with Benign Paroxysmal Positional Vertigo (BPPV) who demonstrated the unusual phenomenon of spontaneously reversing nystagmus, and discuss the theorised mechanisms with a novel illustration. In left lateral position, our patient's Videonystagmography (VNG) demonstrated an initially fast‐phase geotropic nystagmus (leftward‐beating, SPV 29°/s) which then paused for 8 s, then spontaneously reversed direction into a slow‐phase ageotropic nystagmus (rightward‐beating, SPV 7°/s). The rest of the neurootological examination and audiometry were normal. An MRI Brain scan also revealed no intracranial pathology. In subsequent reviews the vertigo resolved after repositioning manoeuvres for Left Horizontal Canal BPPV. With review of existing literature, this case may have exhibited coexistent left canalolithiasis and cupulolithiasis, resulting in simultaneous ampullopetal then ampullofugal forces in a single head position. Other posited theories include that of Endolymphatic Reflux and short‐term central adaptation of the Vestibulo‐Ocular Reflex. This case highlights a diagnostic challenge the otolaryngologists and neurologists may face with an atypical spontaneously reversing nystagmus in BPPV. However it remains a priority to rule out central pathologies first, and calls for specialists to take care in diagnosing horizontal canal BPPV by observing for a period of latency and spontaneous reversal of nystagmus first, so as to perform the appropriate repositioning manoeuvres. Laryngoscope, 2024

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Spontaneous inversion of nystagmus without a positional change in the horizontal canal variant of benign paroxysmal positional vertigo

Abstract: The coexistence of cupulolithiasis and canalolithiasis appears to be a possible mechanism of the spontaneous inversion of positional nystagmus.

Cited by 9 publications

References 12 publications

Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Short-Term Central Adaptation in Benign Paroxysmal Positional Vertigo

Spontaneous Direction-Changing or Reversing Positional Nystagmus without Changing Head Position during Head-Roll/Head-Hanging Maneuvers: Biphasic Positional Nystagmus

An Unusual Phenomenon of Spontaneously Reversing Nystagmus in Peripheral Vertigo—A Case Report and Literature Review

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