Spontaneous Upbeat Nystagmus and Selective Anterior Semicircular Canal Hypofunction on Video Head Impulse Test: A New Variant of Canalith Jam?

被引:4
作者
Castellucci, Andrea [1 ]
Botti, Cecilia [1 ,2 ]
Martellucci, Salvatore [3 ]
Malara, Pasquale [4 ]
Delmonte, Silvia [1 ]
Lusetti, Francesca [1 ]
Ghidini, Angelo [1 ]
机构
[1] Azienda USL IRCCS Reggio Emilia, ENT Unit, Dept Surg, Viale Risorgimento 80, I-42123 Reggio Emilia, Italy
[2] Univ Modena & Reggio Emilia, PhD Program Clin & Expt Med, Modena, Italy
[3] Azienda USL Latina, ENT Unit, Santa Maria Goretti Hosp, Latina, Italy
[4] Centromed, Audiol & Vestibol Serv, Bellinzona, Switzerland
关键词
Vertical nystagmus; Otoconia; Head impulse test; Benign paroxysmal positional vertigo; Semicircular canals;
D O I
10.7874/jao.2021.00297
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
We describe a rare case of spontaneous upbeat nystagmus (UBN) attributable to a canalith jam involving the anterior semicircular canal (ASC) in a patient in whom comprehensive vestibular assessment was useful to identify the underlying pathomechanism. A 56-year-old woman with unsteadiness following repositioning procedures for left-sided benign paroxysmal positional vertigo (BPPV) presented with spontaneous UBN that showed slight right torsional components. A vestibular test battery detected isolated left ASC hypofunction on a video-head impulse test (Video-HIT). We postulated a persistent utriculopetal deflection of the left ASC cupula, which was attributable to entrapment of debris in a narrow canal tract, with consequent sustained inhibition of the ampullary afferents. Although spontaneous UBN receded after impulsive physical therapy, unsteadiness deteriorated into positional vertigo secondary to canalolithiasis involving the ipsilateral posterior canal. In our view, physical therapy possibly fragmented the canalith jam and released free-floating otoconia that eventually settled into the ipsilateral posterior canal. Video HIT revealed normalization of ASC hypofunction, and left-sided posterior canal canalolithiasis was successfully treated using appropriate repositioning procedures. We propose that a canalith jam involving the ASC should be considered in the differential diagnosis of spontaneous UBN, particularly in patients with a history of BPPV and isolated ASC hypofunction detected on video HIT.
引用
收藏
页码:153 / 159
页数:7
相关论文
共 15 条
[1]   Positional down beating nystamus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis [J].
Bertholon, P ;
Bronstein, AM ;
Davies, RA ;
Rudge, P ;
Thilo, KV .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2002, 72 (03) :366-372
[2]   Fluctuating Posterior Canal Function in Benign Paroxysmal Positional Vertigo Depending on How and Where Otoconia Are Disposed [J].
Castellucci, Andrea ;
Malara, Pasquale ;
Martellucci, Salvatore ;
Delmonte, Silvia ;
Ghidini, Angelo .
OTOLOGY & NEUROTOLOGY, 2021, 42 (02) :E193-E198
[3]   Feasibility of Using the Video-Head Impulse Test to Detect the Involved Canal in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus [J].
Castellucci, Andrea ;
Malara, Pasquale ;
Martellucci, Salvatore ;
Botti, Cecilia ;
Delmonte, Silvia ;
Quaglieri, Silvia ;
Rebecchi, Elisabetta ;
Armato, Enrico ;
Ralli, Massimo ;
Manfrin, Marco Lucio ;
Ghidini, Angelo ;
Libonati, Giacinto Asprella .
FRONTIERS IN NEUROLOGY, 2020, 11
[4]   The effect of superior canal dehiscence size and location on audiometric measurements, vestibular-evoked myogenic potentials and video-head impulse testing [J].
Castellucci, Andrea ;
Piras, Gianluca ;
Del Vecchio, Valeria ;
Crocetta, Francesco Maria ;
Maiolo, Vincenzo ;
Ferri, Gian Gaetano ;
Ghidini, Angelo ;
Brandolini, Cristina .
EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY, 2021, 278 (04) :997-1015
[5]   Spontaneous downbeat nystagmus in posterior semicircular canal benign paroxysmal positional vertigo: a canalith jam? [J].
Castellucci, Andrea ;
Malara, Pasquale ;
Ghidini, Angelo .
NEUROLOGICAL SCIENCES, 2021, 42 (01) :313-315
[6]   Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss [J].
Castellucci, Andrea ;
Malara, Pasquale ;
Brandolini, Cristina ;
Del Vecchio, Valeria ;
Giordano, Davide ;
Ghidini, Angelo ;
Ferri, Gian Gaetano ;
Pirodda, Antonio .
AMERICAN JOURNAL OF OTOLARYNGOLOGY, 2019, 40 (02) :319-322
[7]   Recent advances in head impulse test findings in central vestibular disorders [J].
Choi, Jeong-Yoon ;
Kim, Hyo-Jung ;
Kim, Ji-Soo .
NEUROLOGY, 2018, 90 (13) :602-612
[8]   Persistent Spontaneous Nystagmus Following a Canalith Repositioning Procedure in Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo [J].
Ko, Kyung Min ;
Song, Mee Hyun ;
Kim, Ji Hong ;
Shim, Dae Bo .
JAMA OTOLARYNGOLOGY-HEAD & NECK SURGERY, 2014, 140 (03) :250-252
[9]  
Leigh RJ., 2015, The neurology of eye movements, DOI DOI 10.1093/MED/9780199969289.001.0001
[10]   Spontaneous Jamming of Horizontal Semicircular Canal Combined with Canalolithiasis of Contralateral Posterior Semicircular Canal [J].
Martellucci, Salvatore ;
Castellucci, Andrea ;
Malara, Pasquale ;
Pagliuca, Giulio ;
Clemenzi, Veronica ;
Stolfa, Andrea ;
Gallo, Andrea ;
Libonati, Giacinto Asprella .
JOURNAL OF AUDIOLOGY AND OTOLOGY, 2022, 26 (01) :55-60