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Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis.

Abstract Benign paroxysmal positional vertigo (BPPV) involving horizontal semicircular canal (HSCC) is characterized by direction-changing positional nystagmus (DCPN) in a supine roll test, and the occurrence of spontaneous nystagmus in HSCC BPPV has been reported recently. The aim of this study is to investigate the characteristics of pseudo-spontaneous nystagmus (PSN) in patients with HSCC canalolithiasis, and evaluate the effect of the presence of PSN on treatment outcome.Between April 2014 and January 2016, 75 and 59 patients with HSCC canalolithiasis and cupulolithiasis, respectively, were enrolled. Spontaneous and positional nystagmus were examined.PSN was observed in 31 of 75 patients (41%) with HSCC canalolithiasis, and 55 of 59 patients (93%) with HSCC cupulolithiasis. PSN persisted during the period of observation, which was at least 1 minute in all patients with PSN. In HSCC canalolithiasis, direction-reversing nystagmus was observed in 58 patients (25 bilateral and 33 unilateral). Nine of 25 patients with bilateral direction-reversing nystagmus, and 22 of 33 patients with unilateral direction-reversing nystagmus showed PSN. None of 17 patients without direction-reversing nystagmus showed PSN. The direction of PSN corresponded to that of direction-reversing nystagmus in all 22 patients with unilateral direction-reversing nystagmus. The proportion of patients who recovered after 1 session of repositioning maneuver was not significantly different between patients with and without PSN (P = .867).PSN was observed more commonly in HSCC cupulolithiasis than canalolithiasis. The pathophysiologic mechanism underlying PSN can be explained by natural inclination of HSCC and medial to lateral orientation of the HSCC cupular axis in cupulolithiasis, and by spontaneous reversal of initial positional nystagmus (direction-reversing nystagmus) generated by short-term adaptation of vestibulo-ocular reflex in canalolithiasis. The presence of PSN in HSCC canalolithiasis may not affect the treatment outcome.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834895
OWN - NLM
STAT- MEDLINE
DA  - 20170823
DCOM- 20170912
LR  - 20170912
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Pseudo-spontaneous nystagmus in horizontal semicircular canal canalolithiasis.
PG  - e7849
LID - 10.1097/MD.0000000000007849 [doi]
AB  - Benign paroxysmal positional vertigo (BPPV) involving horizontal semicircular
      canal (HSCC) is characterized by direction-changing positional nystagmus (DCPN)
      in a supine roll test, and the occurrence of spontaneous nystagmus in HSCC BPPV
      has been reported recently. The aim of this study is to investigate the
      characteristics of pseudo-spontaneous nystagmus (PSN) in patients with HSCC
      canalolithiasis, and evaluate the effect of the presence of PSN on treatment
      outcome.Between April 2014 and January 2016, 75 and 59 patients with HSCC
      canalolithiasis and cupulolithiasis, respectively, were enrolled. Spontaneous and
      positional nystagmus were examined.PSN was observed in 31 of 75 patients (41%)
      with HSCC canalolithiasis, and 55 of 59 patients (93%) with HSCC cupulolithiasis.
      PSN persisted during the period of observation, which was at least 1 minute in
      all patients with PSN. In HSCC canalolithiasis, direction-reversing nystagmus was
      observed in 58 patients (25 bilateral and 33 unilateral). Nine of 25 patients
      with bilateral direction-reversing nystagmus, and 22 of 33 patients with
      unilateral direction-reversing nystagmus showed PSN. None of 17 patients without 
      direction-reversing nystagmus showed PSN. The direction of PSN corresponded to
      that of direction-reversing nystagmus in all 22 patients with unilateral
      direction-reversing nystagmus. The proportion of patients who recovered after 1
      session of repositioning maneuver was not significantly different between
      patients with and without PSN (P = .867).PSN was observed more commonly in HSCC
      cupulolithiasis than canalolithiasis. The pathophysiologic mechanism underlying
      PSN can be explained by natural inclination of HSCC and medial to lateral
      orientation of the HSCC cupular axis in cupulolithiasis, and by spontaneous
      reversal of initial positional nystagmus (direction-reversing nystagmus)
      generated by short-term adaptation of vestibulo-ocular reflex in canalolithiasis.
      The presence of PSN in HSCC canalolithiasis may not affect the treatment outcome.
FAU - Im, Dong Hyuk
AU  - Im DH
AD  - Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University
      Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
FAU - Yang, Young Soo
AU  - Yang YS
FAU - Choi, Hyerang
AU  - Choi H
FAU - Choi, Seongjun
AU  - Choi S
FAU - Shin, Jung Eun
AU  - Shin JE
FAU - Kim, Chang-Hee
AU  - Kim CH
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Benign Paroxysmal Positional Vertigo/epidemiology
MH  - Female
MH  - Humans
MH  - Labyrinth Diseases/*epidemiology
MH  - Lithiasis/*epidemiology
MH  - Male
MH  - Middle Aged
MH  - Nystagmus, Pathologic/*epidemiology
MH  - Patient Positioning
MH  - Semicircular Canals/*pathology
MH  - Vestibular Function Tests
MH  - Young Adult
PMC - PMC5572017
EDAT- 2017/08/24 06:00
MHDA- 2017/09/13 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007849 [doi]
AID - 00005792-201708250-00032 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7849. doi: 10.1097/MD.0000000000007849.