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“Sitting-up Vertigo as an expression of posterior semicircular canal heavy cupula and posterior semicircular canal short arm canalolithiasis”

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Journal of Otology 2022年第2期17卷 101-106页

作者： Darío H.Scocco María A.Barreiro Ivan E.García Institute of Neuroscience Favaloro Foundation University HospitalBuenos AiresArgentina

Background:Vestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists.Recently,a benign paroxysmal positional Vertigo(BPPV)variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal(P-SCC)cupula stimulation on sitting-up was described and named sitting-up Vertigo BPPV.A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism.Objective:To describe new mechanisms of action for the sitting-up Vertigo BPPV variant.Methods:Eighteen patients with sitting-up Vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings.Results:All patients showed up-beating torsional nystagmus(UBTN)and vestibular symptoms on coming up from either Dix-Hallpike(DHM)or straight head-hanging maneuver.Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver(HH).A slower persistent contratorsional down-beating nystagmus was found in eleven out18 patients tested on nose down position(ND).Conclusions:Persistent direction changing positional nystagmus on HH and ND positions indicative of PSCC heavy cupula was found in 11 patients.A sustained UBTN on HH with the absence of findings on ND,which is suggestive of the presence of P-SCC short arm canalolithiasis,was found on 5 patients.All patients were treated with canalith repositioning maneuvers without success,but they resolved their findings by means of Brandt-Daroff exercises.We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up Vertigo BPPV variant.

关键词： BPPV Benign paroxysmal positional Vertigo Vertigo Residual dizziness Subjective BPPV Sitting up Vertigo Heavy cupula Short arm canalolithiasis

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Complex nystagmus in traumatic benign paroxysmal positional Vertigo:A case study on the critical value of knowing semicircular canal excitation and inhibition patterns

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Journal of Otology 2021年第3期16卷 199-204页

作者： Allison Nogi Michael C.Schubert Department of Physical Medicine and Rehabilitation Johns Hopkins University School of MedicineBaltimoreMDUSA Laboratory of Vestibular NeuroAdaptation Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMDUSA

A 73-year-old female presented to the emergency department with chief complaint of dizziness after sustaining a fall one month prior to dizziness onset.Although careful examination of eye movement patterns during positional testing was attempted at varying stages of her inpatient admission,her complex nystagmus patterns as a result of traumatic benign paroxysmal Vertigo were difficult to manage.In particular,the nystagmus pattern from this case suggests the BPPV was variable and affecting either 1)left posterior semicircular canal(pSCC)exclusively 2)left pSCC and right anterior semicircular canal,3)left and right pSCC canal.This case illustrates the importance of two critical details;positional testing should include observing nystagmus with fixation removed and an experienced clinician should be involved as early as possible.

关键词： Vertigo critical semicircular

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Probable benign paroxysmal positional Vertigo, spontaneously resolved:Incidence in medical practice, patients’ characteristics and the natural course

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Journal of Otology 2019年第3期14卷 111-116页

作者： M.G.Alvarez-Morujo de Sande R. Gonzalez-Aguado G. Guerra-Jimenez E. Domenech-Vadillo H. Galera-Ruiz E. Figuerola-Massana A. Ramos-Macías C. Morales-Angulo A.J. Martín-Mateos E. Domínguez-Duran Hospital Universitario Puerta del Mar Cadiz Spain Hospital Universitario Marques de Valdecilla Santander Spain Complejo Hospitalario Universitario Insular Materno-Infantil Las Palmas de Gran Canaria Spain Hospital Universitari Joan XXIII Tarragona Spain Hospital Infanta Luisa Sevilla Spain

Background: Probable benign paroxysmal positional Vertigo, spontaneously resolved (pBPPVsr), is a variant of benign paroxysmal positional Vertigo (BPPV) in which there is no observable nystagmus and no Vertigo with any positional maneuver. Objectives: To calculate the incidence pBPPVsr, compare the characteristics of the patients with pBPPVsr and BPPV not spontaneously resolved and describe the spontaneous resolution in the natural course of BPPV. Methods: Multicenter prospective descriptive study. During a one-year period, all patients with suspected BPPV that presented to the Neurotology Units of five participating centers were recruited. The incidence of pBPPVsr was calculated as a percentage of the total number of patients with BPPV. The prevalence of several variables was compared between pBPPVsr and BPPV not spontaneously resolved. The timing of spontaneous resolution was estimated using Kaplan-Meier curves. Results: 457 patients met the inclusion criteria. The incidence of pBPPVsr was 33.5%. It was significantly higher in males, in patients with normal bone mass and in patients who were not taking sulpiride. A rate of 18% of spontaneous resolution after the first month and 51% after the first year was found. This percentage did not change in a significant way after this moment. The curves for males, patients under 50 and patients with normal blood pressure decreased significantly faster. Conclusions: In our serie, BPPV spontaneously resolved in half of the patients with BPPV during the first year. This seemed to occur more commonly in males and could have been hindered by sulpiride intake, osteoporosis, advanced age and high blood pressure.

关键词： Benign paroxysmal positional Vertigo Probable benign paroxysmal positional Vertigo, spontaneously resolved Osteoporosis Sulpiride Hypertension

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Vertigo as the sole complaint of tympanomastoid paraganglioma

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Journal of Otology 2020年第1期15卷 33-35页

作者： Xi-Xing Li Wei-Na Cui Guo-Dong Gao Department of Otorhinolaryngology Head and Neck Surgery The Second Hospital of Hebei Medical UniversityShijiazhuangChina Department of Medical Radiology The Second Hospital of Hebei Medical UniversityShijiazhuangChina

Background: Tympanomastoid paragangliomas are usually benign, slowly growing, painless tumors. The common presenting symptoms of this tumor are pulsatile tinnitus and conductive hearing loss. Vertigo as the cardinal or initial symptom is extremely rare, especially in the early stages of the disease.Case presentation: A 53-year-old female patient presented only with intermittent recurrent Vertigo and was later found to have a tympanomastoid paraganglioma. Her symptoms disappeared completely after resection of the tumor. This is the first report in literature of a case of tympanomastoid paraganglioma with Vertigo as the single symptom.Conclusion: The tympanomastoid paraganglioma is rare and its clinical symptoms are nonspecific, so it is easy to be misdiagnosed or missed. It is worth noting that although clinically uncommon, Vertigo can also be the first or sole symptom of tympanomastoid paraganglioma. Detailed physical examination and imaging examination of the ear are necessary and should be carried out meticulously.

关键词： Paraganglioma Glomus tympanicum Vertigo Tympanomastoid

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Analysis of cost and effectiveness of treatment in benign paroxysmal positional Vertigo

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Chinese Medical Journal 2019年第3期132卷 342-345页

作者： Ya-Li Wang Min-Ya Wu Pei-Li Cheng Shao-Fang Pei Yi Liu Ying-Mei Liu Department of Neurology the Northern Area of Suzhou Municipal HospitalSuzhouJiangsu 215000China

To the Editor: Benign paroxysmal positional Vertigo (BPPV) is one of the most common causes of Vertigo. Recently, the diagnosis and treatment of BPPV have become areas of increased interest. As such, the levels of clinical diagnosis and treatment have greatly improved. While studies have been conducted worldwide examining the pathogenesis and pathophysiology of BPPV, very few have focused on the cost of diagnosis and treatment of BPPV. Therefore, the current study was designed to analyze the effects and expenditure of the different treatment strategies for BPPV, according to the effective screening of BPPV patients, and Vertigo classification.

关键词： positional Vertigo Benign paroxysmal positional Vertigo (BPPV) clinical diagnosis

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Safety of different acupuncture manipulations for posterior circulation ischemia with Vertigo

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Neural Regeneration Research 2016年第8期11卷 1267-1273页

作者： Yan Wen Chao Zhang Xiao-feng Zhao Shi-zhe Deng Si He Ling-hui Huang Guang Tian Zhi-hong Meng Department of Acupuncture and Moxibustion First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China Institute of Acupuncture and Moxibustion First Teaching Hospital of Tianjin University of Traditional Chinese Medicine Tianjin China Northern Jiangsu People's Hospital Yangzhou Jiangsu Province China

Acupuncture at Fengchi（GB20） in the posterior neck improves Vertigo.However,subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck.Therefore,in the present study,we assessed the safety of acupuncture at Fengchi.Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with Vertigo.A total of 136 patients were randomly assigned to four groups.Verum acupuncture was conducted with different needle insertion directions（contralateral paropia or prominentia laryngea） and different needle twisting frequencies（60 or 120 times/minute） at Fengchi and matching acupoints（for example,Zhongwan [CV12],Qihai [CV6],Zusanli [ST36],and Fenglong [ST40]）.The patients received 14 treatments over 3–4 weeks.Routine blood analysis,hepatic and renal function tests,urine and feces tests and electrocardiography were performed before the first treatment session and after the final session.Adverse events were recorded after every session.Of the 136 patients,120 completed the study.There were no significant differences between pretreatment and posttreatment test results in any of the groups.Only five patients suffered from minor adverse events（needling pain,slight hematoma and transient chest tightness）.No serious adverse events were found.Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with Vertigo.

关键词： nerve regeneration posterior circulation ischemia Vertigo acupuncture direction twisting frequency Fengchi （GB20） adverse event safety neural regeneration

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Acute isolated Vertigo with vertical up-beating nystagmus: A rare case of nucleus intercalatus of Staderini ischemia

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中华耳科学杂志:英文版 2023年第4期18卷 246-249页

作者： Francesco Comacchio Giacomo Talenti Renzo Manara Chiara Briani Otolaryngology Unit University Hospital Sant’Antonio PadovaVia Facciolati 7135127PadovaItaly Neuroradiology Unit University Hospital PadovaVia Giustiniani 235128PadovaItaly Neurology Unit University Hospital PadovaVia Giustiniani 235128PadovaItaly

The role of intercalatus nucleus of Staderini(INS),the most caudal of the perihypoglossal nuclei,is much debated.Last research seems to suggest that this nucleus plays a role as a vertical eyes movements integrator.The few clinical reports present in the literature that describe isolated lesions of the INS have described patients presenting in acute with up-beating vertical spontaneous nystagmus.Isolated acute lesion of INS is,in fact,much rare,and,without other neurological signs,is exceptional.We present a case of acute isolated Vertigo with no other neurological signs or symptoms,due to INS ischemia provoked by vertebral artery stenosis.The patient presented with spontaneous vertical up-beating nystagmus that showed at videonystagmographic recording,a clear exponential decay of angular slow-phase velocity,that is considered a typical sign of neural integrator impairment.This case seems to represent a further confirm that INS is part,as a vertical-to-position neural integrator,of the neural circuit controlling the vertical eyes movements.

关键词： Vertigo Up-beating nystagmus Intercalatus nucleus Staderini Vertebral artery occlusion Brainstem ischemia

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Age predicts the absence of caloric-induced Vertigo

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Journal of Otology 2018年第1期13卷 5-9页

作者： Gary P.Jacobson Erin G.Piker Sarah L.Grantham Lauren N.English Department of Hearing and Speech Sciences Divisions of Audiology and Vestibular Sciences Vanderbilt University Medical Center Nashville TN USA Department of Communication Sciences and Disorders James Madison University Harrisonburg VA USA

Introduction: The absence of Vertigo during the caloric test, despite a robust response, has been suggested to represent a central vestibular system phenomenon. The purpose of this investigation was to determine the prevalence of absent caloric-induced Vertigo perception in an unselected group of patients and to assess possible predicting variables.Methods: Prospective investigation of 92 unselected patients who underwent caloric testing. Inclusion criteria were that each patient generate a maximum slow phase velocity(maxSPV) > 15 deg/sec and a caloric asymmetry of≤10%. Following the caloric, patients were asked, "Did you have any sensation of motion?"Results: Results showed 75% of patients reported motion with a mean age of 56.51 years compared to a mean age of 66.55 in the 25% of patients reporting an absence of motion. A logistic regression was performed and the overall model was statistically significant accounting for 29% of the variance in caloric perception. The significant predictor variables were patient age and maxSPV of the caloric response. The effect size for both variables was small with an odds ratio of.9 for maxSPV and 1.06 for age.Conclusions: The current investigation showed that both age and maxSPV of the caloric response were significant predictors of Vertigo perception during the caloric exam. However, the association between age and caloric perception is not conclusive. Although there is evidence to suggest that these findings represent age-related changes in the central processing of vestibular system stimulation, there are additional unmeasured factors that influence the perception of caloric-induced Vertigo.

关键词： Vestibular Vertigo Central processing Caloric test Aging

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Treatment of benign paroxysmal positional Vertigo. A clinical review

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Journal of Otology 2017年第4期12卷 165-173页

作者： Paz Perez-Vazquez Virginia Franco-Gutierrez ENT Department Hospital Universitario de Cabuenes Gijon Spain ENT Department Hospital Universitario Marques de Valdecilla Santander Spain

Benign paroxysmal positional Vertigo(BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.

关键词： Benign Paroxysmal Positional Vertigo Treatment Vestibular disorder

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Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional Vertigo

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Journal of Otology 2015年第3期10卷 115-117页

作者： Jinrang Li Pengfei Guo Shiyu Tian Keliang Li Hao Zhang Department of Otorhinolaryngology Head Neck Surgery Navy General Hospital

Objective:To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional Vertigo (H-BPPV). Methods:Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180? from the involved side towards contralateral side as quickly as possible. Results:Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion:The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV. Copyright ? 2015 The Authors. Production & hosting by Elsevier (Singapore) Pte Ltd On behalf of PLA General Hospital Department of Otolaryngology Head and Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://***/licenses/by-nc-nd/4.0/).

关键词： Vertigo Vestibular diseases Horizontal semicircular canal Repositioning maneuver

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