A patient with positional vertigo

Abstract

A. Concomitant involvement of the left posterior and right lateral canal. As the patient had concomitant involvement of two canals on opposite sides, we decided to treat the lateral canal first, as the symptoms were more pronounced in the test for lateral canal benign paroxysmal positional vertigo (BPPV). After repeating the “barrel roll” maneuver twice, no more symptoms or nystagmus were observed in the lateral canal BPPV test. The next morning we repeated the Dix–Hallpike test, which was again positive on the left side. The lateral canal BPPV test was negative. We then proceeded to the Epley maneuver, and after only one repeat, the patient was without symptoms or nystagmus. Of all the inner ear disorders that can cause dizziness or vertigo, BPPV is the most common.[1]Parnes L.S. Agrawal S.K. Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV).CMAJ. 2003; 169: 681-693PubMed Google Scholar In a series of 2,345 patients with BPPV, single-canal BPPV occurred in 98.5% of patients, while multiple-canal BPPV occurred in 1.5%.[2]Tomaz A. Ganança M.M. Ganança C.F. et al.Benign paroxysmal positional vertigo: concomitant involvement of different semicircular canals.Ann Otol Rhinol Laryngol. 2009; 118: 113-117PubMed Google Scholar Of these 35 patients with multiple-canal BPPV, there was simultaneous involvement of the posterior and lateral canals on opposite sides in only nine. The mechanism of BPPV in our patient was canalolithiasis, based on the direction of the nystagmus. Although posterior canal BPPV is the most common variant of BPPV, this report emphasizes the importance of testing for lateral canal BPPV, even if the Dix–Hallpike test is positive. A patient with positional vertigoJournal of Clinical NeuroscienceVol. 19Issue 7PreviewA 37-year-old, otherwise healthy female presented to our emergency room complaining of vertigo. The symptoms started after lunch when she was lying in bed: they were paroxysmal, short in duration and provoked by turning on either side in bed. She also complained of nausea, but she did not vomit. Full-Text PDF