Sun-Uk Lee1, Hyo-Jung Kim, Ji-Soo Kim. 1. *Department of Neurology, Ajou University College of Medicine, Ajou University Hospital, Suwon; †Kangwon National University College of Medicine, Medical Research Institute, Seoul National University Bundang Hospital, Seongnam; and ‡Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Abstract
OBJECTIVES: To determine the characteristics and diagnostic value of pseudo-spontaneous and head-shaking nystagmus (HSN) in benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). STUDY DESIGN: Retrospective case series review. METHODS: After excluding 19 patients with canal paresis, abnormal head impulse test, recent history of peripheral or central vestibular disorders, or poor cooperation, we retrospectively recruited 127 patients with HC-BPPV from January 2009 to July 2012. The patients included 69 geotropic and 58 apogeotropic types. We analyzed the pattern of pseudo-spontaneous nystagmus and HSN according to the lesion side. RESULTS: Pseudo-spontaneous nystagmus was observed in 87 (87/127, 68.5%) patients, both in geotropic (46/69, 66.7%) and apogeotropic (41/58, 70.7%) types without difference in the prevalence between the types (p = 0.627). Pseudo-spontaneous nystagmus beat more to the lesion side in apogeotropic type (28/41, 68.3%, p = 0.028) but in either direction without directional preponderance in geotropic type (p = 0.659). Of the 90 patients who underwent horizontal head-shaking, 27 (30.0%) showed HSN that was more common in apogeotropic than in geotropic type (22/44 [50.0%] versus 5/46 [10.9%], p < 0.001). Patients with apogeotropic HC-BPPV showed predominantly contralesional HSN (19/22 [86.4%], p = 0.001), whereas patients with geotropic type did not show any directional preponderance of HSN (contralesional in 2 and ipsilesional in 3). CONCLUSION: HSN is more common and mostly contralesional in apogeotropic HC-BPPV. HSN may be a lateralizing sign in apogeotropic HC-BPPV. Different prevalence and patterns of HSN in apogeotropic and geotropic HC-BPPV suggest dissimilar cupular dynamics in those disorders.
OBJECTIVES: To determine the characteristics and diagnostic value of pseudo-spontaneous and head-shaking nystagmus (HSN) in benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). STUDY DESIGN: Retrospective case series review. METHODS: After excluding 19 patients with canal paresis, abnormal head impulse test, recent history of peripheral or central vestibular disorders, or poor cooperation, we retrospectively recruited 127 patients with HC-BPPV from January 2009 to July 2012. The patients included 69 geotropic and 58 apogeotropic types. We analyzed the pattern of pseudo-spontaneous nystagmus and HSN according to the lesion side. RESULTS: Pseudo-spontaneous nystagmus was observed in 87 (87/127, 68.5%) patients, both in geotropic (46/69, 66.7%) and apogeotropic (41/58, 70.7%) types without difference in the prevalence between the types (p = 0.627). Pseudo-spontaneous nystagmus beat more to the lesion side in apogeotropic type (28/41, 68.3%, p = 0.028) but in either direction without directional preponderance in geotropic type (p = 0.659). Of the 90 patients who underwent horizontal head-shaking, 27 (30.0%) showed HSN that was more common in apogeotropic than in geotropic type (22/44 [50.0%] versus 5/46 [10.9%], p < 0.001). Patients with apogeotropic HC-BPPV showed predominantly contralesional HSN (19/22 [86.4%], p = 0.001), whereas patients with geotropic type did not show any directional preponderance of HSN (contralesional in 2 and ipsilesional in 3). CONCLUSION: HSN is more common and mostly contralesional in apogeotropic HC-BPPV. HSN may be a lateralizing sign in apogeotropic HC-BPPV. Different prevalence and patterns of HSN in apogeotropic and geotropic HC-BPPV suggest dissimilar cupular dynamics in those disorders.
Authors: Scott D Z Eggers; Alexandre Bisdorff; Michael von Brevern; David S Zee; Ji-Soo Kim; Nicolas Perez-Fernandez; Miriam S Welgampola; Charles C Della Santina; David E Newman-Toker Journal: J Vestib Res Date: 2019 Impact factor: 2.354
Authors: Salvatore Martellucci; Pasquale Malara; Andrea Castellucci; Rudi Pecci; Beatrice Giannoni; Vincenzo Marcelli; Alfonso Scarpa; Ettore Cassandro; Silvia Quaglieri; Marco Lucio Manfrin; Elisabetta Rebecchi; Enrico Armato; Francesco Comacchio; Marta Mion; Giuseppe Attanasio; Massimo Ralli; Antonio Greco; Marco de Vincentiis; Cecilia Botti; Luisa Savoldi; Luigi Califano; Angelo Ghidini; Giulio Pagliuca; Veronica Clemenzi; Andrea Stolfa; Andrea Gallo; Giacinto Asprella Libonati Journal: Front Neurol Date: 2020-11-19 Impact factor: 4.003