Benign paroxysmal positional vertigo due to a simultaneous involvement of both horizontal and posterior semicircular canals.
From April 2001 to November 2003, we investigated 8 patients with benign paroxysmal positional vertigo (BPPV) that was suspected to simultaneously affect both the horizontal and posterior semicircular canals (HSCC and PSCC). These cases showed typical vertical-torsional nystagmus induced by the Dix-Hallpike maneuver, followed by a horizontal nystagmus. They also showed a direction-changing geotropic or apogeotropic positional nystagmus triggered by lateral head rotations in the supine position. Using the three-dimensional analysis of the positional nystagmus, the rotation axis of the positional nystagmus had a component perpendicular to the plane of PSCC and another component perpendicular to the plane of HSCC. All these findings suggest that BPPV in these patients was a combination of posterior and horizontal canal BPPV. The observation of a vertical-torsional positional nystagmus should prompt the specialist to perform not only the canalith repositioning procedure, but also to execute lateral head turns in the supine position.
Department of Otolaryngology, Kansai-Rosai Hospital, Hyogo, and Department of Otolaryngology, Osaka Universityu Medical School, Japan. imaitakao@hotmail.com
Takao
T
Imai
Noriaki
N
Takeda
Mahito
M
Ito
Koji
K
Nakamae
Hideki
H
Sakae
Hiromu
H
Fujioka
Takashi
T
Matsunaga
Takeshi
T
Kubo
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007759:Labyrinth Diseases / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009759:Nystagmus, Pathologic; D012665:Semicircular Canals / Q000473:pathology*; D014717:Vertigo / Q000209:etiology* / Q000473:pathology; D014724:Vestibular Function Tests