KISEP Otology Korean J Otolaryngol 1999;42:576-81 외측반규관기원의양성발작성두위안진 연세대학교의과대학이비인후과학교실 정운교 이원상 김문석 이주환 이세영 Direction Changing Positional Nystagmus from Canalolithiasis and Cupulolithiasis of Lateral Semicircular Canal Woon Kyo Chung, MD, Won-Sang Lee, MD, Moon Suk Kim, MD, Joo-Hwan Lee, MD and Sei Young Lee, MD Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and Objectives:Clinical features of positional nystagmus may be different according to the etiology. Thus, efforts have been made to find out etiologies of various positional nystagmus. Until recently, positional vertigo was thought to arise from lesions of central nervous system. However, more recent investigations suggest that the peripheral lesion may be the main cause. Moreover, there have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the lateral semicircular canal. The objectives of the study were to investigate the etiologies and clinical aspects of DCPN (direction changing positional nystagmus) from canalolithiasis and cupulolithiasis of the lateral semicircular canal, and to assess the effectiveness of the treatment. Materials and Methods:Among 15 patients with DCPN, 9 patients showed nystagmus compatible with canalolithiasis of lateral semicircular canal and 6 patients with cupulolithiasis of lateral semicircular canal. Patients with cupulolithiasis and canalithiasis of the lateral semicircular canal did not respond to physical therapy for posterior semicircular canal. However, they were completely recovered by reposition maneuver for the lateral semicircular canal with or without using vibrator although 3 of them had recurred symptom. Four patients had BPPV of the posterior semicircular canal prior to the development of DCPN and 3 patients underwent the treatment of previous Meniere's disease. Conclusion:The patients with DCPN were due to canalithiasis and cupulolithiasis of the lateral semicircular canal, and physical therapy for lateral semicircular canal was rewarding. (Korean J Otolaryngol 1999;42:576-81) KEY WORDS:Direction changing positional nystagmus Benign paroxysmal positional vertigo Cupulo- and canalolithiasis of lateral semicircular canal. 576
Table 1. Characteristics of DCPN according to type of lesion Canalolithiasis Cupulolithiasis Vertigo duration Short Short Latency Less than 30 seconds more than 30 seconds Geotropic transient Ageotropic persistent Nystagmus pure horizontal pure horizontal Baloh RW, Halmagyi GM. Disorder of the vestibular system. New York Oxford 1996335 A B Fig. 1. Geotropic transient nystagmus of the patients with canalolithiasis in the right lateral semicircular canal. ALeft head rotation induces transient left beating nystagmus Duration of nystagmus was 15 seconds and Vmax was 17 sec. hdlhead left rotation, hdr head right rotation. BRight head rotation induces transient right beating nystagmus Duration of of nystagmus is 30 seconds and Vmax is 40sec. hdl head left rotation, hdrhead right rotation. 577
Fig. 2. Ageotropic persistent nystagmus in cupular type Head left rotation position induces right beating ageotropic persistent nystagmus. hdlhead left rotation, hdrhead right rotation. 578 Korean J Otolaryngol 1999;42:576-81
Table 2. Number, age distribution and vertigo duration of canalolithiasis and cupulolithiasis of the lateral semicircular canal Lateral canalolithiasis Lateral cupulolithiasis Number 9 6 Age 30 1 0 31 59 3 0 60 5 6 Duration of vertigo 1 week 3 0 1 week 1 month 4 5 1 month 2 1 Table 3. Etiologies of canalolithiasis and cupulolithiasis of the lateral semicircular canal Canalolithiasis Etiology 3 Cupulolithiasis Meniere's diasease 2 1 Head trauma 1 1 Posterior BPPV* 1 Lateral cupulolithiasis 2 Unknown 9 4 Total 9 6 BPPV*benign paroxysmal positional vertigo Fig. 3. One positiondirection changing positional nystagmus in right canalolithiasis type Head right rotation position induced right beating nystagmus initially after 40 seconds it turns into left beating nystagm-us. hdl head left rotation, hdr head right rotation. 579
Fig. 4. Canalolithiasis of right lateral semicircular canal. Fig. 5. Cupulolithiasis of right lateral semicircular canal. 580 Korean J Otolaryngol 1999;42:576-81
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