Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders an...Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management.Methods:In a retrospective review of cases from an ambulatory tertiary referral center,patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres,were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored,until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed.Results:Fifteen patients were studied.All but one[14/15 cases]showed a positive therapeutic response to the repositioning procedure in a single session.In two cases,a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase.Although in three patients the affected ear was not initially identified,it was ultimately identified and successfully treated by the square wave manoeuvre in all of them.Conclusions:The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction,where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.展开更多
Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down...Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.展开更多
Background: The utricular macula is located on the floor of the utricle, approximately in the plane of the lateral semicircular canal, and is oriented to respond best to lateral tilts and side-to-side or fore-and-aft ...Background: The utricular macula is located on the floor of the utricle, approximately in the plane of the lateral semicircular canal, and is oriented to respond best to lateral tilts and side-to-side or fore-and-aft translations of the head. However, the details of the otolith ocular reflex are unknown. Pathophysiology of transient direction-changing geotropic positional nystagmus is a canalolithiasis in the lateral semicircular canal. The principle of affected-ear-up 90° maneuver is moving debris from a long arm to the utricle, therefore debris stimulates the utricular macula in the sitting position after the treatment. Objective: To clarify whether nystagmus occurs by the stimulation to the macula of the utricle. Methods: The subjects were 10 patients with lateral semicircular canal canalolithiasis. After the diagnosis, we performed affected-ear-up 90° maneuver immediately. We observed eye movements in the sitting position (chin-down 30°) just after the treatment. Results: No one showed nystagmus in the sitting position after the treatment. In all patients, positional nystagmus disappeared within 7 days after the treatment. Conclusion: Nystagmus does not occur by the stimulation to the macula of the utricle. Hence, we cannot assess the function of the utricle by the analysis of eye movements, and ocular counter-rolling is considered to be a semicircular canal ocular reflex.展开更多
文摘Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management.Methods:In a retrospective review of cases from an ambulatory tertiary referral center,patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres,were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored,until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed.Results:Fifteen patients were studied.All but one[14/15 cases]showed a positive therapeutic response to the repositioning procedure in a single session.In two cases,a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase.Although in three patients the affected ear was not initially identified,it was ultimately identified and successfully treated by the square wave manoeuvre in all of them.Conclusions:The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction,where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.
基金the National Natural Science Foundation of China(No.81500794,No.81271078 and No.81500791)Scientific Research Project of Hubei Province Health and Family Planning(No.WJ2015MB062).
文摘Objective The purpose of the study was to evaluate the efficiency of the supine roll test(SRT)and alternative positional tests(APTs)including the bow and lean test(BLT),pseudo-spontaneous nystagmus(PSN),and lying down nystagmus(LDN)to identify the affected side in horizontal canal benign paroxysmal positional vertigo(HC-BPPV).Methods In our prospective study,we performed a testing profile(PSN,BLT,LDN,SRT)on 59 HC-BPPV patients using videonystagmography.We compared the accuracy and sensitivity of these tests in HC-BPPV lateralization.Data from 30 healthy patients were collected as the control group.Results When performing positional tests,the elicited nystagmus coinciding with Ewald’s second law was defined as a“positive response”.In 44 patients with geotropic nystagmus,the rates of positive response in LDN,PSN,and BLT were 22/44(50%),19/44(43%),and 18/44(41%),respectively,while in 15 patients with apogeotropic nystagmus,the positive response rates of these three tests were 10/15(66.7%),9/15(60%),and 4/15(27.00%),respectively.The sensitivity of LDN(54.38%)was higher than that of PSN(47.37%)and BLT(38.60%)but lower than that of SRT(89.47%).Notably,the accuracy rate of PSN(71.8%)was higher than that of the other APTs.In 6 patients with symmetrical nysgtamus during the roll test,5 patients showed a positive response in both LDN and BLT(83.34%),whereas 4 patients showed a positive response in PSN(66.67%).Conclusion All positional tests are helpful for determining the affected side of HC-BPPV,but SRT carries the highest accuracy of lateralization followed by PSN.
文摘Background: The utricular macula is located on the floor of the utricle, approximately in the plane of the lateral semicircular canal, and is oriented to respond best to lateral tilts and side-to-side or fore-and-aft translations of the head. However, the details of the otolith ocular reflex are unknown. Pathophysiology of transient direction-changing geotropic positional nystagmus is a canalolithiasis in the lateral semicircular canal. The principle of affected-ear-up 90° maneuver is moving debris from a long arm to the utricle, therefore debris stimulates the utricular macula in the sitting position after the treatment. Objective: To clarify whether nystagmus occurs by the stimulation to the macula of the utricle. Methods: The subjects were 10 patients with lateral semicircular canal canalolithiasis. After the diagnosis, we performed affected-ear-up 90° maneuver immediately. We observed eye movements in the sitting position (chin-down 30°) just after the treatment. Results: No one showed nystagmus in the sitting position after the treatment. In all patients, positional nystagmus disappeared within 7 days after the treatment. Conclusion: Nystagmus does not occur by the stimulation to the macula of the utricle. Hence, we cannot assess the function of the utricle by the analysis of eye movements, and ocular counter-rolling is considered to be a semicircular canal ocular reflex.