Vertical nystagmus during the seated–supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo

Yetışer, Sertaç; İnce, Dilay

doi:10.1017/s0022215114001480

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…Even though SHH was already incorporated into the maneuvers to induce positional nystagmus by Nylén, 20 its role in diagnosing PC-BPPV remains to be delineated. Instead, its role has mostly been confined to diagnosing central positional nystagmus or BPPV involving the anterior or horizontal semicircular canals, 21 22 23 24 even though a study conducted in China found positional nystagmus typical of PC-BPPV in 22 (78.6%) of 28 patients with PC-BPPV during SHH, which is similar to the findings of the present study. 15…”

Section: Discussionsupporting

confidence: 88%

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

et al. 2021

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Background and Purpose To determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). Methods We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before ( n =29, group A) or after ( n =33, group B) the Dix-Hallpike maneuver. Results Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p =0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p <0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups ( p =0.082). Conclusions SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.

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Section: Discussionsupporting

confidence: 88%

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

et al. 2021

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“…In case of BPPV, a period of latency is usually seen at the beginning of nystagmus until cupular inertia is disturbed following head-down lying movement and positional nystagmus will eventually finish after termination of cupular tilting or termination of endolymphatic flow due to movement of freely floating (canalolithiasis) or attached cristaloids (cupulolitiasis). On the other hand, multiple canal involvement of BPPV, particularly bilateral or pseudobilateral involvement of posterior canal should be borne in mind since vertical up-beating nystagmus is seen not only during Dix-Hallpike maneuver on both sides but also during straight head hanging position ( Yetiser and Ince, 2014 ).…”

Section: Discussionmentioning

confidence: 99%

Acute thrombosis of the carotid artery associated with positional nystagmus at multiple planes

2019

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Objective An acute onset central pathology without any clear neurological symptoms may mimic peripheral vestibular problem in an emergency setting. A 54-year-old man suddenly developed dizziness without any cranial nerve symptoms, paresis, cerebellar signs or sensory disturbances except upbeat positional nystagmus at multiple provoked positions which alerted for a possible acute central pathology. Findings An instantaneous magnetic resonance imaging and angiography studies further showed obstruction of the left internal carotid artery above the bifurcation. The patient’s subsequent prognosis was consistent with good recovery following anti-coagulant therapy. A follow-up MRI and angiography showed resolution of thrombosis. Conclusion It should be kept in mind that positional nystagmus is likely to occur in central pathologies. Differentiation between benign paroxysmal positional vertigo and central positioning nystagmus is critical.

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“…Reports indicate the diagnostic role of vertical nystagmus during the lying down or straight headhanging test. [6][7][8] However, one may erroneously suspect a central nervous system disorder, as this vertical nystagmus is generally more persistent than other types of positional nystagmus. 8 Finally, symptomatic relief after Epley's manoeuvre applied on the side with more intense manifestation is evidence of pseudo bilateral BPPV, which is unlikely in true bilateral cases.…”

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] However, one may erroneously suspect a central nervous system disorder, as this vertical nystagmus is generally more persistent than other types of positional nystagmus. 8 Finally, symptomatic relief after Epley's manoeuvre applied on the side with more intense manifestation is evidence of pseudo bilateral BPPV, which is unlikely in true bilateral cases. Observation of vertiginous symptoms in patients during the Dix-Hallpike manoeuvre on the pathological side will also give some clues of true bilateral BPPV.…”

Section: Introductionmentioning

confidence: 99%

Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo

Yetışer

İnce

2023

J. Laryngol. Otol.

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Objective To outline the clinical picture of bilateral posterior canal benign paroxysmal positional vertigo. Methods A total of 573 patients with posterior canal benign paroxysmal positional vertigo were classified as having unilateral, or true or pseudo bilateral, posterior canal benign paroxysmal positional vertigo, and were treated with the Epley manoeuvre. Statistical significance was set at p < 0.05. Results Of the patients, 483 had unilateral and 90 (15.7 per cent) had bilateral presentation. Of the latter, 72 patients had pseudo bilateral posterior canal benign paroxysmal positional vertigo. Comparisons of site of involvement, male to female ratio and the incidence of associated problems in unilateral, and true and pseudo bilateral posterior canal benign paroxysmal positional vertigo did not reveal any statistically significant differences (p = 0.828, p = 0.200, p = 0.142). Comparisons of the number of manoeuvres required to provide symptom relief and the rate of recurrence were significant (p < 0.05). Conclusion Identification of true and pseudo bilateral posterior canal benign paroxysmal positional vertigo is important given the differences in aetiology and treatment outcome. Treatment of patients with true bilateral posterior canal benign paroxysmal positional vertigo requires several therapeutic manoeuvre attempts, and patients should be warned about recurrence.

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Vertical nystagmus during the seated–supine positional (straight head-hanging) test in patients with benign paroxysmal positional vertigo

Abstract: In patients with benign paroxysmal positional vertigo, the presence of vertical up-beating nystagmus while lying down is a unique peripheral sign and could indicate multiple canal involvement. Therefore, the seated-supine positional test should always be included in the test battery.

Cited by 6 publications

References 13 publications

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo

Acute thrombosis of the carotid artery associated with positional nystagmus at multiple planes

Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo

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