The Video Head Impulse Test in the acute stage of posterior canal benign paroxysmal positional vertigo

Califano, Luigi; Iannella, Raffaella; Mazzone, Salvatore; Salafia, Francesca; Melillo, Maria Grazia

doi:10.14639/0392-100x-n1033

Cited by 20 publications

(23 citation statements)

References 31 publications

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“…A partial canal jam might determine impaired responses for high-frequency stimuli, such as head impulses in v-HIT, whereas low-frequency stimuli, such as the cupular stimulus of the endolymph flow activated during the positional test, remain active (low-pass filter). Data reported by Castellucci et al 23 highlight the difference between APC and TPC, in which the posterior canal VOR gain is not affected 24 .…”

Section: Discussionmentioning

confidence: 90%

Less common forms of posterior canal benign paroxysmal positional vertigo

Califano¹,

Mazzone²,

Salafia³

et al. 2021

Acta Otorhinolaryngol Ital

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The most common form of posterior canal benign paroxysmal positional vertigo (BPPV) is characterised by positional, paroxysmal, upbeat nystagmus, with a torsional component beating towards the downward ear. Rarer variants have been reported, putatively due to either the position of otoconia in the canal or anatomic variations of the semicircular canals. The most frequent less common form is apogeotropic posterior canal BPPV, in which the positional nystagmus is downbeat and torsional apogeotropic. In this form, the main problems are differential diagnosis with central mimics of BPPV and identification of the affected canal and its side. The authors propose a new subtype of apogeotropic posterior canal BPPV hypothesising the localization of otoconia in the ampullary tract of the affected canal, which might explain the modality of the conversion in typical posterior canal BPPV which they observed in some of these cases. If nystagmus of the less common forms of posterior canal BPPV is explicable through purely peripheral mechanisms, these forms should no longer be defined as "atypical" but, in a less demanding way, as "less common" variants, which must be recognised by any expert otoneurologist.

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Section: Discussionmentioning

confidence: 90%

Less common forms of posterior canal benign paroxysmal positional vertigo

Califano¹,

Mazzone²,

Salafia³

et al. 2021

Acta Otorhinolaryngol Ital

Self Cite

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“…Several explanations have been proposed. Disturbance of endolymphatic hydrodynamics in the posterior SCC due to free-floating particles (canalithiasis) has been suggested ( 21 ), but this hypothesis remains controversial as other investigators found no significant impairment of VOR gain for the affected posterior SCC in patients with PC-BPPV involving the ampullary arm ( 22 , 23 ). Canalith jam, either partial or complete type, could lead to decreased VOR gain in response to vHIT.…”

Section: Discussionmentioning

confidence: 99%

Video Head Impulse Test Findings in Patients With Benign Paroxysmal Positional Vertigo Secondary to Idiopathic Sudden Sensorineural Hearing Loss

et al. 2022

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Benign paroxysmal positional vertigo (BPPV) is amongst the most common causes of episodic vestibular syndrome. It can be classified as idiopathic and secondary types according to the causative factors, and the underlying mechanism between idiopathic (i-BPPV) and secondary BPPV (s-BPPV) may differ. Idiopathic sudden sensorineural hearing loss (ISSNHL) has been considered as a common inner ear disease that precipitates s-BPPV. Yet, few studies have addressed the functional impairment of the semicircular canal (SCC) system in patients with s-BPPV associated with ISSNHL. Our purpose was to explore the pathophysiological mechanism and investigate the clinical implications of video head impulse test (vHIT) in these patients. Here, the clinical and laboratory data of patients with BPPV secondary to ISSNHL, including the results of vHIT, were retrospectively reviewed, and compared with those of patients with i-BPPV. Pathological vHIT findings (low vestibulo-ocular reflex gain and re-fixation saccade), which mainly affected the posterior SCC, were more common in the s-BPPV group than in the i-BPPV group (41.9 and 0%, respectively). The incidence of horizontal SCC involvement was also higher in the s-BPPV group (45.16 and 16.67%, respectively). Furthermore, patients with s-BPPV showed lower vHIT gains of the posterior and horizontal SCCs in affected ears than in unaffected ears. Compared to i-BPPV, posterior SCC paresis detected by vHIT is more prevalent in BPPV secondary to ISSNHL. This dysfunction may be associated mainly with vestibular impairments caused by ISSNHL, and not with BPPV per se.

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“…In individuals with persistent positional DBN, with or without torsion in the DH positions and SHHP and without nystagmus on return to upright, the video head impulse test (vHIT) was able to detect the involved vertical canal of the coplanar pair, either PC-BPPV canal obstruction or AC-BPPV ( 36 , 37 ). However, in typical acute PC-BPPV, the vHIT was unable to identify the involved canal ( 38 ). In this case, the vHIT was not used to identify the involved canal.…”

Section: Discussionmentioning

confidence: 99%

Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis

Helminski

2022

Front. Neurol.

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BackgroundAtypical posterior canal (PC) positional nystagmus may be due to the changes in cupular response dynamics from cupulolithiasis (cu), canalithiasis of the short arm (ca-sa), or a partial/complete obstruction—jam. Factors that change the dynamics are the position of the head in the pitch plane, individual variability in the location of the PC attachment to the utricle and the position of the cupula within the ampulla, and the location of debris within the short arm and on the cupula. The clinical presentation of PC-BPPV-cu is DBN with torsion towards the contralateral side in the DH positions and SHHP or no nystagmus in the ipsilateral DH position and no nystagmus upon return to sitting from each position. The clinical presentation of PC-BPPV-ca-sa is no nystagmus in the DH position and upbeat nystagmus (UBN) with torsion lateralized to the involved side upon return to sitting from each position.Case descriptionA 68-year-old woman, diagnosed with BPPV, presented with DBN associated with vertigo in both DH positions and without nystagmus or symptoms on sitting up. In the straight head hanging position (SHHP), the findings of a transient burst of UBN with left torsion associated with vertigo suggested ipsicanal conversion from the left PC-BPPV-cu to canalithiasis. Treatment included a modified canalith repositioning procedure (CRP), which resulted in complete resolution. BPPV recurred 17 days later. Clinical presentation of BPPV included no nystagmus/symptoms in both the contralateral DH position and SHHP, DBN in the ipsilateral DH position without symptoms, and UBN with left torsion associated with severe truncal retropulsion and nausea on sitting up from provoking position. The findings suggested the left PC-BPPV-cu-sa and PC-BPPV-ca-sa. Treatment included neck extension, a modified CRP, and demi-Semont before complete resolution.ConclusionAn understanding of the biomechanics of the vestibular system is necessary to differentially diagnose atypical PC-BPPV. DH test (DHT) findings suggest that PC-BPPV-cu presents with DBN or no nystagmus in one or two DH positions and sometimes SHHP and without nystagmus or no reversal/reversal of nystagmus on sitting up. The findings suggest PC-BPPV-ca-sa has no nystagmus in DH positions or DBN in the ipsilateral DH position and UBN with torsion lateralized to the involved side on sitting up.

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The Video Head Impulse Test in the acute stage of posterior canal benign paroxysmal positional vertigo

Cited by 20 publications

References 31 publications

Less common forms of posterior canal benign paroxysmal positional vertigo

Less common forms of posterior canal benign paroxysmal positional vertigo

Video Head Impulse Test Findings in Patients With Benign Paroxysmal Positional Vertigo Secondary to Idiopathic Sudden Sensorineural Hearing Loss

Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis

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