Sitting Up Vertigo. Proposed Variant of Posterior Canal Benign Paroxysmal Positional Vertigo

Abstract

Objective: To describe a variant of posterior canal benign paroxysmal positional vertigo (BPPV).

Study design: Retrospective case review.

Setting: Tertiary referral center.

Patients: Fifteen patients with symptoms of BPPV and oculomotor evidence of activation of posterior semicircular canal (P-SCC) cupula that arises when sitting up from Dix-Hallpike maneuver (DH).

Intervention: All patients were examined with videonystagmography and underwent brain magnetic resonance imaging (MRI).

Results: All patients showed up-beating nystagmus with ipsilateral torsional component when coming up from right or left side DH. Most patients described vertiginous symptoms when sitting up from bed and many described severe non-positional disequilibrium. Eight patients had been treated with Epley canalith repositioning maneuver (CRM) at our clinic for posterior canal BPPV. Four of them were re-tested within an hour for CRM effectiveness and the rest, a week later. Three patients had been diagnosed with BPPV and were being treated with CRM in other institutions. Four patients showed these findings but they had not previously undergone CRM. All patients were treated with CRM without success, but they resolved their positional vertigo by means of Brandt Daroff exercises. No patient showed evidence of central vestibular disorder.

Conclusion: We propose a P-SCC canalolithiasis limited to the periampullar portion by means of an anatomical restriction of distal movement of the otoconial debris. This syndrome seems to be more frequent early after CRM of classical P-SCC canalolithiasis. Close attention to ocular movement on sitting up after DH on patients is warranted.