UNUSUAL POSITIONAL NYSTAGMUS IN RIGHT POSTERIOR CANAL BPPV
This video shows Dix-Hallpike testing done by Dr. Ajay Kumar Vats, D.M. (Neurology), Udaipur (Rajasthan), India, on a 36 year old female patient with right posterior semicircular canal BPPV, which is the commonest form of positional vertigo. This elicits a geotropic upbeat nystagmus in the Hallpike position (diseased ear undermost). This patient did not have any head trauma in recent or remote past but her preferable sleeping position was left lateral. The positional nystagmus appeared after latency of about 14 seconds, lasted for 66 seconds, and was relatively very slow which is unusual. Initially positional nystagmus in the Dix-Hallpike position could not be appreciated and so the Dix-Hallpike test was repeated after ten minutes and video recording was done. In the video recording the positional torsional upbeat geotropic nystagmus was appreciated by watching the movements of pterygium in the right eye or conjunctival vessels in the left eye. The other unusual feature in this patient was lack of unwinding of positional nystagmus when patient was made to sit up. After confirming the existence of positional nystagmus, its latency and fatigability on video recording, the patient was subjected to Epley maneuver with which patient was asymptomatic post-procedure.
Posted December 3, 2010 at 8:56 PM