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Review
. 2020 Sep 15:11:1040.
doi: 10.3389/fneur.2020.01040. eCollection 2020.

Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Francisco Zuma E Maia  1 , Bernardo Faria Ramos  2 , Renato Cal  3 , Camila Martins Brock  4 , Pedro Luiz Mangabeira Albernaz  5 , Michael Strupp  6   7
Affiliations
Review

Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Francisco Zuma E Maia et al. Front Neurol. .

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.

Keywords: apogeotropic nystagmus; benign paroxysmal positional vertigo; canalolithiasis; cupulolithiasis; geotropic nystagmus; horizontal semicircular canal; lateral semicircular canal; repositioning maneuvers.

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Figures

Figure 1
Figure 1
Gufoni's new maneuver for left apogeotropic LC-BPPV. Data modified from Ciniglio Appiani et al. (44).
Figure 2
Figure 2
Modified Semont maneuver for left apogeotropic LC-BPPV. Data modified from Casani et al. (48).
Figure 3
Figure 3
Cupulolith repositioning maneuver (CuRM) for right apogeotropic LC-BPPV. Data modified from Kim et al. (49).
Figure 4
Figure 4
Zuma Maneuver for right apogeotropic LC-BPPV. Data modified from Ramos et al. (36) and Zuma e Maia (50).
Figure 5
Figure 5
Roll maneuver for right geotropic LC-BPPV. Data modified from Lempert and Tiel-Wilck (55).
Figure 6
Figure 6
Forced Prolonged Position for right geotropic LC-BPPV. Data modified from Vannucchi et al. (46).
Figure 7
Figure 7
Gufoni maneuver for right geotropic LC-BPPV. Data modified from Ciniglio Appiani et al. (65).
Figure 8
Figure 8
Modified Zuma maneuver for right geotropic LC-BPPV. Data modified from Ramos et al. (71).
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