ASN » BPPV

Differential diagnosis between bppv and mppv in direction-changing positional

admin — Thu, 01 Jan 2004 00:00:00 +0000

For many years, it has gave description as MPPV (Malignat Paroxysmal Positiona
l Vertigo) that direction-changing positional nystagmus is caused by central n
erve system disorders
Recently it became evident that direction-changing positional nystagmus is cau
sed by horizontal canal type of BPPV (HC-BPPV).
The clinical signs of HC-BPPV and MPPV are closely resembled. They have short
latent time and long duration, no fatigability. So we desire the effective cli
nical examination for differential diagnosis eagerly.
Although vertigo in most cases of BPPV disappears within a month, we are often
confused refractory vertigo with direction-changing positional nystagmus.
Our investigation of them reveals that the visual suppression test and inspect
ive check for the direction change in nystagmus are useful for differential di
agnosis.

Paroxysmal positional vertigo revisited: is it benign, pseudo-benign or malignant?

admin — Wed, 01 Jan 2003 00:00:00 +0000

Dix and Hallpike firstly described Benign Paroxysmal Positional Vertigo(BPPV) in 1952. Since then, this disease have been widely recognized among clinicians. There are some charactstic symptoms such as, having critical head position, being pure rotatory nystagmus with the phenomenon of crescendo and decrescendo, having fatigue phenomenon on provocation of the vertiginous attack.. Pathogenesis of the BPPV is explained by the dysfunction of otolith in a inner ear.
Pseudo-BPPV firstly described by present authors about 25 years ago. Symptoms are characterized by closely resembled to that of BPPV. It is a pure rotatory counter-rolling positional or positioning nystagmus with a latent period. We also have found less fatigability of the provoked vertiginous attacks. The pathological lesion located in cerebellar vermis and the nature of pathology is all cerebellar infarction.
Among Paroxysmal Vertigo, there is a type of vertigo with vertical nystagmus. This vertiginous attack can be provoked by positional or positioning test repeatedly showing no fatigue phenomenon. Lesion of the malignant type is also located in cerebellar vermis but the nature of the pathology is different from that of Pseudo-BPPV.
Diagnosis of the PPV is important for the treatment. Most of the patient of the BPPV are elderly, therefore, procedures of the replacement therapy may increase the risks to provoke iatrogenic cerebrovascular disorders

Endolymphatic hydrops patients with benign paroxysmal positioning vertigo

admin — Wed, 01 Jan 2003 00:00:00 +0000

Objective: Amongst the reasons causing the inner ear pathology being accompanied by fits of giddiness, the most frequently occurring are the endolymphatic hydrops & benign paroxysmal positioning vertigo (BPPV). In the whole number of scientific articles there may be found the mentioning of patients with the combination of BPPV & Menier’s Disease. The reasons & probably the mechanisms for both conditions’ origin are somewhat similar within the frameworks of known theories.
The purpose of the present research is the scrutiny of labyrinth hydrops occurrence amongst the patients suffering from BPPV.

Methods: Within the course of the present work to diagnose the disease we used the whole battery of tests & examinations performed by neurotologist & neurologist. The investigation of the vestibular system state & condition has been carried out with the use of VISUAL EYES – videonystamography complex with the infra-red registering of eyes’ movements (By Micromedical Technologies). The examination of hearing has been performed in audiological laboratory, whilst the endolymphatic hydrops has been registered by method of extratympanic electrocochleography upon the system BRAVO (by NICOLET) with the application of the generally accepted criteria.

Results: We have examined the patients’ group with BPPV – totaling 94 patients. Amongst them 28 patients (29,8%) with endolymphatic hydrops has been discovered. Distribution by gender: 2 males and 26 females. The average age within the examined group of patients with the combination of hydrops & BPPV – 49.75 years old. The duration of disease: from 1 month to 16 years.

Within the afore group of patients the following reasons for the development of disease has been discovered: idiopathic – 75%, virus infection -–10.7%, acute stress – 7.1%, trauma – 7.1%.

The outset of disease has been accompanied by the following symptoms:
Spinning-32.1%, positional spinning – 32.1%, dizzy – 46.6%, noise in ears – 10.7%, reduction of hearing – 2%, the loss of conscience – 3.6%.
From 28 patients of the said group – 2 has been diagnosed with the Menier’s disease, 26 – with the secondary hydrops.

Within the afore group of patients the pathology of only the posterior semicircular channels has been registered (from the right in 39.3%, from the left – in 57.1%, of both – 3.6%). The distribution of the hydrops localizing in relation towards the BPPV pathology side was the following: while with the otolithiasis of the right posterior semicircular channel the hydrops has been registered from the right in 14.3% of cases, from the left in 14,3% of cases, from both sides – in 10.7%. Whilst with the otolithiasis from the left – the hydrops has been registered in left ear in 28.6% of cases, from the right – in 7.1%, and in both ears – 21.4%.

Considering the presence of both pathological conditions, the following therapy tactics has been chosen by ourselves. Upon the first stage we have used the rehabilitation manoeuvres, exercises & their combinations designed for BPPV correction. Thus the Epley manoeuvre has been applied in 85,7% of cases. The exercises of Brandt-Daroff – in 42,9% of cases.

The significant element for the successful therapy within the afore group of patients as per our judgement – has been the complex therapy of the second stage. The above therapy consisted in the use of special diet, short course of diuretics, Betaserk & its combination with other medications depending upon the character of the attendant diseases. Some patients have been treated with the course of osteopathic correction, massage from the alterations in the cervical part of the vertebral spine.

Conclusion: Taking into account the frequently occurring combination of BPPV & labyrinth hydrops we strongly recommend the inclusion of EcoG into the programm for examination of patient with the positional vertigo, especially with the persisting dizzy symptoms after performing of the rehabilitational manoeuvre. We have not discovered the combination of inner ear hydrops & BPPV by the localizing side. The course specially designed to manage the said patient with the whole combination of diseases has to obligatorily include the rehabilitational treatment methods co-jointly with the medicational therapy.

Bppv and vasopressine

admin — Mon, 01 Jan 2001 00:00:00 +0000

The possible relationship between inner ear and vasopressin (AVP, ADH) has been hypothesized since twenty years ago
About ten years ago, in anaesthetized guinea pigs, we demonstrated that changes in the inner ear pressure modify plasma AVP (pAVP) level and AVP secretion with consequent changes in urine flow rate and osmolality : our experiment was performed in a group of anaesthetized Guinea pig, in which we acutely augmented (protocol 1) and decreased (protocol 2) the inner ear pressure, when the inner ear pressure was decreased, we observed an increase of plasmatic ADH values and urinary osmolarity, meanwhile the urinary flow rate decreased; whereas when the inner ear pressure was augmented, we observed opposite effects………

The many faces of bppv: therapeutic results in 464 cases

admin — Mon, 01 Jan 2001 00:00:00 +0000

It has been demonstrated not only in our experimental research as well as in our clinical routine that the association of different strategies is usually highly synergic for positional vertigo relief and control. The summation of the various favourable effects of each kind of therapy seems to lead to an improvement or cure which is quicker and longer standing than with a single therapy.An integrated balance therapy was prescribed, with an emphasis on the obligatory attempt to remove or control a presumable etiologic agent, and also including vestibular suppressants, vestibular rehabilitation techniques (canalith repositioning procedure, liberatory maneuver, roll maneuver, home execises, etc.) nutritional and habit recommendations. A group of 464 patients with the diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) was submmitted to the integrated balance therapy program. The selection of the appropriate rehabilitative procedure was based on the identification of the involved canal and type of pathology (canalithiasis or cupulolithiasis) in each BPPV case.A laboratory monitoring of the treatment was always done in order to evaluate the patient’s evolution and change the treatment protocol if necessary. We have reevaluated the patient every 30 or 60 days. Around 85% of the patients with BPPV presented a favourable evolution in this study. In 10% of the cases the improvement was not significant even though a presumable adequate therapy was prescribed. The difficulty to adhere completely to the therapeutic protocol seems to be the main reason behind most of the treatment failures. Only 5% of the BPPV patients were totally non-responsive to the integrated balance therapy.