Paolo Vannucchi

Benign paroxysmal vertigo of the horizontal canal.

Over a period of 4 years we observed 15 cases of benign positional vertigo (BPV) probably caused by deposition of otoliths in the horizontal semicircular canal. Rapid rolling onto one side in recumbent position provokes a paroxysmal, purely horizontal and geotropic nystagmus which nearly always spontaneously inverts direction. Rolling the patient onto the other side provokes a left intense geotropic nystagmus. BPV is more violent but resolves more rapidly than that of the better known posterior canal positional vertigo. Sometimes both syndromes are present together.

Benign Paroxysmal Positional Vertigo of the Horizontal Canal: A Form of Canalolithiasis with Variable Clinical Features

Benign paroxysmal positional vertigo of the horizontal semicircular canal (HC-BPPV) is a well-defined syndrome characterized by direction-changing horizontal positional nystagmus. We report the clinical features of 5 patients who illustrate the possible variables of the syndrome. In most cases, nystagmus is geotropic and more intense when the pathological ear is lowermost; less often the syndrome presents with apogeotropic nystagmus that is more intense when the affected ear is uppermost. The nystagmus pattern may vary in time in the same patient, changing from apogeotropic to geotropic even in observations at short intervals. In some patients, the features indicate involvement of more than one canal, either simultaneously or in succession. It is sustained that the clinical findings can be explained by movement of endolymph caused by displacement of otoconia in the semicircular canals and that variants are due to different positions of the otoconia within the canals.

Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV

The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC‐BPPV) motivated the present double‐blind randomized trial on the short‐term efficacy of the Gufoni liberatory maneuver (GLM).

Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo Presenting with Torsional Downbeating Nystagmus: An Apogeotropic Variant

The aim of this study is to verify the hypothesis that free-floating particles could sometimes localize into the distal portion of the non ampullary arm of the posterior semicircular canal (PSC) so that assuming the Dix-Hallpikes positions, the clot could move towards the ampulla eliciting a inhibitory torsional-down beating paroxysmal positional nystagmus (PPNy), instead of typical excitatory torsional-up beating PPNy. Among 45 patients with vestibular signs suggesting anterior semicircular canal paroxysmal positional vertigo (PPV), collected from February 2003 to August 2006, we detected a group of 6 subjects whose clinical findings showed a singular behaviour during follow-up. At the first check-up, all patients were submitted to different types of physical manoeuvres for ASC canalolithiasis. Patients were controlled during the same session and after one week. When we found that nystagmus was qualitatively changed we adopted the appropriate physical therapies for that sign. At a next check-up, after having performed some physical therapies, all patients had a typical PSC PPNy of the opposite side, with respect to that of the ASC initially diagnosed. Basing on these observations we conclude that PSC PPV, similarly to lateral semicircular canal PPV, could manifests in a apogeotropic variant.

Can emergency physicians accurately and reliably assess acute vertigo in the emergency department

To validate a clinical diagnostic tool, used by emergency physicians (EPs), to diagnose the central cause of patients presenting with vertigo, and to determine interrater reliability of this tool.

The Physical Treatment of Lateral Semicircular Canal Canalolithiasis

The authors describe the different techniques for physical therapy of benign paroxysmal positional vertigo of the lateral semicircular canal. All are based on one of three mechanisms: barbeque manoeuvres in which the canals are quickly rotated, so that material heavier than endolymph is induced to move toward the vestibule; repositioning manoeuvres in which debris is induced to move under the force of gravity; brisk deceleration manoeuvres in the plane of the affected canal in which debris is induced to move out of the canal. The authors report good results from different techniques and they suggest a strategy for the treatment of LSC-BPV; they prefer manoeuvres which can bring about immediate recovery. After a few days, it is useful to see patients again, because LSC-BPV may transform into PSC-BPV.

Lateral Canal BPPV: Which is the Affected Side?

Lateral canal BPPV is due to detached otoconia that enter the lateral canal instead of the posterior canal. It is characterized by paroxysmal positional nystagmus which is horizontal instead of vertical-torsional. A geotropic form and a less common apogeotropic form are recognised. The pathological side, which must be identified for successful physical treatment, is usually indicated by nystagmus intensity: the more intense positional nystagmus beats towards the affected ear. In a few cases, there is no evident difference in nystagmus intensity, making it necessary to determine the affected ear on the basis of other indicators.

Pathophysiology of lateral semicircular canal paroxysmal positional vertigo

OBJECTIVE To study the pathophysiology of lateral semicircular canal (LSC) paroxysmal positional vertigo (PPV). STUDY DESIGN Retrospective study. METHODS Between June 2004 and June 2005 we observed 471 patients with PPV. In the apogeotropic forms of LSC-PPV, we tried to transform the nystagmus into the geotropic form, either by diagnostic or therapeutic menoeuvres. If we failed, we advised barbecue rotations toward the healthy side and sleeping on the affected side. Patients were evaluated once a week until resolution. RESULTS 91 patients suffered LSC involvement, in 61 cases in the geotropic form and in 30 cases in the apogeotropic form. Out of these, five transformed into the geotropic form during the first examination; in 5 patients we observed geotropic nystagmus at the follow-up visit; the last 20 never showed geotropic nystagmus before resolution. CONCLUSION We hypothesize that in the geotropic form the debris is free floating in the posterior arm of the LSC (canalolithiasis). In the apogeotropic form the debris can be free floating in the anterior arm or attached to the cupula of the ampulla; if we observe transformation from the apogeotropic into the geotropic form this suggested a canalolithiasis, otherwise we have assumed a cupulolithiasis.

About Nystagmus Transformation in a Case of Apogeotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

There are two forms of lateral semicircular canal benign paroxysmal positional vertigo: geotropic and apogeotropic. When the pathophysiological mechanism of the apogeotropic form is that of canalolithiasis, we can observe a transformation from an apogeotropic nystagmus into a geotropic one. Usually, this phenomenon happens simultaneously on both sides, thus enabling us to observe a right-beating paroxysmal positional nystagmus when the patient lies on the right side and a left-beating paroxysmal positional nystagmus on the left side. We describe a case in which the transformation occurred gradually, so that, after three head rotations from side to side in supine position, there was a right nystagmus beating toward the ground (geotropic) with the patient on the right side and a right nystagmus beating away from the ground (apogeotropic) on the left side. However, after further rotations we observed the nystagmus transformation also on the left side, with a geotropic nystagmus on both sides. The phenomenon of gradual transformation could happen because initially only a part of the debris moved from the anterior to the posterior aspect of the canal during head rotations.

Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects

The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine.