Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease, and it is one of the first causes of access to the emergency room. The moment of migration of the otoconial debris in a semicircular canal does not necessarily coincide with the moment of detachment of the debris themselves. Consequently, the paroxysmal positional vertigo could arise with a variable delay with respect to the mechanical damage suffered by the macula. The aim of this work is to try to identify objective criteria to establish whether a canalolithiasis is synchronous or diachronic to the damage. The analysis of skew deviation in the context of ocular tilt reaction in patients with canalolithiasis could provide useful information to understand if macular damage occurred at the origin of the disease and when the damage may have occurred. In this study, 38 patients with BPPV were analyzed based on the type of skew deviation that was presented. We found that if the eye on the side of the canalolithiasis is hypotropic the damage of the utriculus is likely recent (last 10 days), if it is hypertropic the damage is not recent (20 days before) and finally if the eyes are at the same height it could be an utricular damage in compensation (occurring the last 10–20 days) or a secondary labyrinth canalolithiasis, without associated utricular damage. Our results show that the evaluation of skew deviation in patients suffering from BPPV could be useful to evaluate: (a) if a positional paroxysmal nystagmus can be related to an previous relevant injury event (for example a head injury that occurred days before the crisis); (b) if it is a BPPV of recent onset or a re-entry of the debris into the canal.
Highlights
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular endorgan disease and it is characterized by a sudden, transient vertigo which is accompanied by the typical paroxysmal positional nystagmus
We hypothesize that the study of the skew deviation could give important information regarding the timing of the onset of a paroxysmal positional vertigo
The aim of this paper is to identify objective criteria to establish whether a BPPV occurs at the same time as the damage of utricle or subsequently
Summary
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular endorgan disease and it is characterized by a sudden, transient vertigo which is accompanied by the typical paroxysmal positional nystagmus. BPPV is caused by otoconia that have become detached from the utricular maculae. Analysis of the Skew Deviation in BPPV and ocular Vestibular Myogenic Potentials, provide the possibility to detect the functionality of the utricular and saccular maculae. By the above-mentioned tests, a damage of the utricular and saccular macula could be detected in BPPV [2, 3]. Skew deviation (SD) is a vertical misalignment of the eyes caused by damage to prenuclear vestibular input to ocular motor nuclei. It is usually accompanied by binocular torsion, torticollis, and a tilt in the subjective visual vertical. This constellation of findings has been termed as ocular tilt reaction (OTR). The aim of this paper is to identify objective criteria to establish whether a BPPV occurs at the same time as the damage of utricle or subsequently
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