Clin Exp Otorhinolaryngol.  2012 Dec;5(4):201-206. 10.3342/ceo.2012.5.4.201.

Pseudo-Spontaneous Nystagmus in Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

• Lee HJ
• Kim YH
• Hong SK
• Kim HJ

• KMID: 1489079
• DOI: http://doi.org/10.3342/ceo.2012.5.4.201

Abstract

OBJECTIVES
Spontaneous nystagmus, which has been considered a typical sign of acute vestibulopathy, has recently been reported in benign paroxysmal positional vertigo involving the lateral semicircular canals (LC-BPPV) without unilateral vestibulopathy (pseudo-spontaneous nystagmus, PSN), but research about its clinical application is still limited. Here we investigate the frequency and characteristics of PSN in LC-BPPV patients, and estimate its prognostic value.
METHODS
For 95 patients with LC-BPPV, we examined nystagmus in the sitting position in the clinic with video goggles. Patients were categorized as PSN or non-PSN, according to presence of horizontal nystagmus in the sitting position at diagnosis. The duration of vertiginous symptoms before diagnosis and the duration of treatment were compared between the two groups. The results of video-nystagmography test were reviewed when available.
RESULTS
PSN was examined in 16 (16.8%) patients, all of whose symptoms disappeared immediately after successful repositioning therapy. While the duration of symptoms did not differ statistically between groups (P=0.481), the duration of treatment in the PSN group was significantly longer than in the non-PSN group (P<0.001).
CONCLUSION
We conclude that the presence of spontaneous nystagmus in the sitting position does not preclude a diagnosis of LC-BPPV without unilateral vestibulopathy. PSN was related to a poor outcome of LC-BPPV in this study.

Keyword

Benign paroxysmal positional vertigo; Pathologic nystagmus; Semicircular canals

MeSH Terms

Eye Protective Devices
Humans
Nystagmus, Pathologic
Semicircular Canals
Vertigo
Vertigo

Figure

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  Fig. 1 Video nystagmograms showing pseudo-spontaneous nystagmus (PSN) and positional nystagmus in representative cases of LC-BPPV. (A) A case of geotropic type involving the right ear. Left-beating PSN (7 degree/second) is recorded. In supine roll test, geotropic nystagmus is recorded in the head right (18 degree/second, directing to the right side) and head left (13 degree/second, direction to the left side) position. When the positional test is performed in the pitch plane, lying-down nystagmus and bending-over nystagmus are directed to the same (left-beating, 8 degree/second) and to the opposite direction (right-beating, 8 degree/second) as the PSN, respectively. (B) A case of apogeotropic type involving the left ear. Left-beating PSN (8 degree/second) is recorded. Apogeotropic type nystagmus is examined in the supine roll test (left-beating, 146 degree/second with the head turned to the right; right-beating, 57 degree/second to the left). In the pitch plane, the direction of evoked nystagmus was the same as the direction for PSN in the lying down position (left-beating, 79 degree/second), and to the opposite direction in the bending over position (right-beating, 47 degree/second). LC-BPPV, benign paroxysmal positional vertigo involving the lateral semicircular canal; LH, horizontal component of nystagmus measured on the left eye; LB, nystagmus of which fast component directing to the left side of the patient; RB, nystagmus of which fast component directing to the right side of the patient.

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