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. 2015 Mar 31;5(1):130.
doi: 10.4081/audiores.2015.130. eCollection 2015 Jan 21.

Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations

Paolo Vannucchi  1 , Rudi Pecci  1 , Beatrice Giannoni  1 , Fabio Di Giustino  1 , Rossana Santimone  1 , Arianna Mengucci  1
Affiliations

Apogeotropic Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: Some Clinical and Therapeutic Considerations

Paolo Vannucchi et al. Audiol Res. .

Abstract

We lately reported the cases of patients complaining positional vertigo whose nystagmic pattern was that of a peripheral torsional vertical positional down beating nystagmus originating from a lithiasis of the non-ampullary arm of the posterior semicircular canal (PSC). We considered this particular pathological picture the apogeotropic variant of PSC benign paroxysmal positional vertigo (BPPV). Since the description of the pilot cases we observed more than 150 patients showing the same clinical sign and course of symptoms. In this paper we describe, in detail, both nystagmus of apogeotropic PSC BPPV (A-PSC BPPV) and symptoms reported by patients trying to give a reasonable explanation for these clinical features. Moreover we developed two specific physical therapies directed to cure A-PSC BPPV. Preliminary results of these techniques are related.

Keywords: 45° forced prolonged position; apogeotropic variant; demi Semont; down beating nystagmus; positional vertigo.

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Conflict of interest statement

Conflict of interest: the authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
Paroxysmal positional nystagmus due to unilateral right posterior semicircular canal benign paroxysmal positional vertigo (inhibitory stimulus). A and B) Arrows indicate the direction of nystagmus slow phase in the two eyes; C and D) arrows indicate the ocular muscles involved in nystagmus generation; E and F) the two labyrinths; arrow indicates the endolymphatic flow within the affected canal. A, C and E) The right eye and the right labyrinth; B, D and F) the left eye and the left labyrinth. A, anterior semicircular canal; L, lateral semicircular canal; P, posterior semicircular canal.
Figure 2.
Figure 2.
The nystagmus does not fatigue to repeated positionings. Curved arrows: movements of posterior semicircular canal (PSC) during positionings (head hanging positionings and coming back to sitting position). Straight lines: portion of the PSC in which the debris is trapped.
Figure 3.
Figure 3.
Schematic representation of demi Semont maneuver for a left apogeotropic variant posterior semicircular canal benign paroxysmal positional vertigo (see the text for details). CSP, posterior semicircular canal; CSA, anterior semicircular canal; CSL, lateral semicircular canal.
Figure 4.
Figure 4.
Schematic representation of 45° FPP technique for a left apogeotropic variant posterior semicircular canal benign paroxysmal positional vertigo (see the text for details). CSP, posterior semicircular canal; CSA, anterior semicircular canal; CSL, lateral semicircular canal.
See this image and copyright information in PMC

References

    1. Vannucchi P, Pecci R, Giannoni B. Posterior semicircular canal benign paroxysmal positional vertigo presenting with torsional downbeating nystagmus: an apogeotropic variant. Int J Otolaryngol 2012;2012: 413603. - PMC - PubMed
    1. Bertholon P, Bronstein AM, Davies RA, Rudge P, Thilo KV. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiatry 2002;72:366-72. - PMC - PubMed
    1. Brandt T, Steddin S. Current view of the mechanism of benign paroxysmal positional vertigo: cupulolithiasis or canalithiasis? J Vestib Res 1993;3:373-82. - PubMed
    1. Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 1980;88:599-605. - PubMed
    1. Hall SF, Ruby RRF, McClure JA. The mechanics of benign paroxysmal vertigo. J Otolaryngol 1979;8:151-8. - PubMed

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