RESUMO

OBJECTIVE: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. METHODS: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. RESULTS: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. CONCLUSIONS: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. LEVEL OF EVIDENCE: II a.

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RESUMO

The diagnosis of central positional vertigo (CPV) is challenging, mainly because symptoms overlap with the common variants of benign paroxysmal positional vertigo (BPPV). Recent correlations of imaging with neurotologic exams have improved our understanding of CPV and ability differentiate it from BPPV. Yet, there is still a need to develop better diagnostic algorithms to improve timely diagnosis and early intervention. Here we present a retrospective review of the clinical characteristics, neurotologic evaluation and imaging of CPV in a cohort of 27 patients and propose a diagnostic algorithm to be tested in future prospective fashion. Most patients had positional nystagmus (downbeat and apogeotropic horizontal), cerebellar ocular motor abnormalities and truncal ataxia indicative of a central lesion. 61.5% of our cohort had paroxysmal CPV, 30.5% had a non-paroxysmal CPV and 8% paroxysmal-evolving-to-non-paroxysmal CPV. The most common pattern of positional nystagmus evoked with maneuvers was positional downbeat nystagmus (pDBN, 69.2%), apogeotropic horizontal nystagmus (42.3%), geotropic (7.69%) and multiplanar (23.0%). Notably, 13 (50%) of patients had cerebral imaging prior to CPV being on the differential diagnosis, whereas another 50% of patients had CPV diagnosis preceding their work-up. Unilateral lesions on imaging were 4× less likely to exhibit nausea and vomiting, nearly 2× less likely to exhibit paroxysmal nystagmus, and 2× less likely to exhibit nystagmus with habituality. Findings of pDBN or apogeotropic nystagmus alone were enough to diagnose CPV in 50% of our patient cohort, underscoring the importance of clinical evaluation in a time when an "imaging-first" philosophy is gaining popularity in Neurology.

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Assuntos

RESUMO

Se presenta un estudio realizado en 15 pacientes del Instituto de Oftalmología "Javier Servat Univazo" con el propósito de comprobar la eficacia de la técnica quirúrgica de retroceso-resección de los músculos rectos horizontales del ojo fijador en el nistagmo con bloqueo unilateral y estrabismo, como alternativa de tratamiento quirúrgico que corrige la desviación horizontal y la posición compensadora de la cabeza en el mismo acto quirúrgico. La mejora de torticolis se logró en 11/15 (73 por ciento), y el éxito en el tratamiento de la endotropía fue en 13/15 (87 por ciento); demostrándose que este tratamiento es exitoso para solucionar el problema del Síndrome de Bloqueo del Nistagmo, unilateral (p<0.001>), el cual es accesible al oftalmólogo general

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RESUMO

Surgery for a horizontal face turn or tilt in patients with congenital nystagmus began in 1953 and has been modified frequently since then. There are few published reports stating the frequency of or surgical guidelines for the treatment of a vertical or torsional head position due to congenital nystagmus and associated null point. To address this issue a questionnaire was sent to all members of the American Association for Pediatric Ophthalmology and Strabismus. Most respondents see one or two cases of vertical head posture yearly and use observation as their primary therapy. When surgery is indicated, a graded bilateral vertical rectus recession or combined vertical rectus recession-resection procedure are usually done. Most respondents see no cases of torsional head posture yearly, and an overwhelming majority observe these patients. No one surgical procedure was advocated by most of the responding surgeons.

Assuntos