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Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver

Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM...

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Autor principal: Kim, Yee-Hyuk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803510/
https://www.ncbi.nlm.nih.gov/pubmed/36596008
http://dx.doi.org/10.1097/MD.0000000000032407
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author Kim, Yee-Hyuk
author_facet Kim, Yee-Hyuk
author_sort Kim, Yee-Hyuk
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description Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM); down-beating nystagmus is also observed. This study aims to investigate the clinical characteristics and significance of these findings. We retrospectively reviewed video data showing nystagmus and medical records of adult patients diagnosed with canalolithiasis of the horizontal canal and the posterior canal (PC) BPPV who underwent barbecue maneuver and EM, respectively, in outpatient clinics from April 2014 to March 2019. This study included 112 patients (28 horizontal canal BPPV and 94 PC BPPV cases). Among the 122 BPPV cases, only 14 (14.9%) were analyzed, due to their occurrence during EM. Down-beating nystagmus appeared at 3.6 seconds on average after returning to the sitting position, and the patients fell onto or off the examination table at 4.4 seconds on average after the onset of the nystagmus. The average duration of the down-beating nystagmus was 20.3 seconds. In all 14 cases, no nystagmus was induced by the Dix–Hallpike test performed again after EM, confirming that the treatment was successful. During the EM, down-beating nystagmus and falling onto or off the examination table occurred in approximately 15% of cases. As the risk of falls increases, the patient should be secured immediately after EM. Moreover, it can be inferred that the findings occur when otoconia in the PC enter the utricle, suggesting a successful treatment.
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spelling pubmed-98035102023-01-03 Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver Kim, Yee-Hyuk Medicine (Baltimore) 6000 Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM); down-beating nystagmus is also observed. This study aims to investigate the clinical characteristics and significance of these findings. We retrospectively reviewed video data showing nystagmus and medical records of adult patients diagnosed with canalolithiasis of the horizontal canal and the posterior canal (PC) BPPV who underwent barbecue maneuver and EM, respectively, in outpatient clinics from April 2014 to March 2019. This study included 112 patients (28 horizontal canal BPPV and 94 PC BPPV cases). Among the 122 BPPV cases, only 14 (14.9%) were analyzed, due to their occurrence during EM. Down-beating nystagmus appeared at 3.6 seconds on average after returning to the sitting position, and the patients fell onto or off the examination table at 4.4 seconds on average after the onset of the nystagmus. The average duration of the down-beating nystagmus was 20.3 seconds. In all 14 cases, no nystagmus was induced by the Dix–Hallpike test performed again after EM, confirming that the treatment was successful. During the EM, down-beating nystagmus and falling onto or off the examination table occurred in approximately 15% of cases. As the risk of falls increases, the patient should be secured immediately after EM. Moreover, it can be inferred that the findings occur when otoconia in the PC enter the utricle, suggesting a successful treatment. Lippincott Williams & Wilkins 2022-12-30 /pmc/articles/PMC9803510/ /pubmed/36596008 http://dx.doi.org/10.1097/MD.0000000000032407 Text en Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle 6000
Kim, Yee-Hyuk
Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title_full Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title_fullStr Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title_full_unstemmed Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title_short Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
title_sort clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver
topic 6000
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803510/
https://www.ncbi.nlm.nih.gov/pubmed/36596008
http://dx.doi.org/10.1097/MD.0000000000032407
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