Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus

Jose A Lopez-Escamez, Maria I Molina, Maria J Gamiz
American Journal of Otolaryngology 2006, 27 (3): 173-8

PURPOSE: The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV).

MATERIALS AND METHODS: <AbstractText Label="STUDY DESIGN" NlmCategory="METHODS">This is a prospective case series.

SETTING: The study was set at an outpatient clinic in a general hospital.

PATIENTS: Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver.

INTERVENTION: Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent.

MAIN OUTCOME MEASURES: The main outcome measure is the number of patients without pDBN at 30 and 180 days.

RESULTS: Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers.

CONCLUSIONS: Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.

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