Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.
Identifieur interne : 000380 ( Main/Exploration ); précédent : 000379; suivant : 000381Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.
Auteurs : P. Bertholon [France] ; A M Bronstein ; R A Davies ; P. Rudge ; K V ThiloSource :
- Journal of neurology, neurosurgery, and psychiatry [ 0022-3050 ] ; 2002.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Adulte d'âge moyen (MeSH), Calculs (diagnostic), Canaux semicirculaires osseux (MeSH), Diagnostic différentiel (MeSH), Examen neurologique (MeSH), Femelle (MeSH), Humains (MeSH), Maladies du cervelet (diagnostic), Maladies labyrinthiques (diagnostic), Mâle (MeSH), Nystagmus pathologique (diagnostic), Sujet âgé (MeSH), Vertige (diagnostic), Épreuves vestibulaires (MeSH).
- MESH :
English descriptors
- KwdEn :
- Adult (MeSH), Aged (MeSH), Calculi (diagnosis), Cerebellar Diseases (diagnosis), Diagnosis, Differential (MeSH), Female (MeSH), Humans (MeSH), Labyrinth Diseases (diagnosis), Male (MeSH), Middle Aged (MeSH), Neurologic Examination (MeSH), Nystagmus, Pathologic (diagnosis), Semicircular Canals (MeSH), Vertigo (diagnosis), Vestibular Function Tests (MeSH).
- MESH :
Abstract
OBJECTIVES
To clarify the clinical significance of positional down beat nystagmus (pDBN).
METHODS
A discussion of the neuro-otological findings in 50 consecutive patients with pDBN.
RESULTS
In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two.
CONCLUSION
It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
DOI: 10.1136/jnnp.72.3.366
PubMed: 11861698
PubMed Central: PMC1737794
Affiliations:
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Bertholon</name><affiliation wicri:level="3"><nlm:affiliation>CHU de Saint Etienne, Hopital Bellevue, Saint Etienne, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>CHU de Saint Etienne, Hopital Bellevue, Saint Etienne</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Bronstein, A M" sort="Bronstein, A M" uniqKey="Bronstein A" first="A M" last="Bronstein">A M Bronstein</name></author><author><name sortKey="Davies, R A" sort="Davies, R A" uniqKey="Davies R" first="R A" last="Davies">R A Davies</name></author><author><name sortKey="Rudge, P" sort="Rudge, P" uniqKey="Rudge P" first="P" last="Rudge">P. 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Bertholon</name><affiliation wicri:level="3"><nlm:affiliation>CHU de Saint Etienne, Hopital Bellevue, Saint Etienne, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>CHU de Saint Etienne, Hopital Bellevue, Saint Etienne</wicri:regionArea><placeName><region type="region">Auvergne-Rhône-Alpes</region><region type="old region">Rhône-Alpes</region><settlement type="city">Saint-Étienne</settlement></placeName></affiliation></author><author><name sortKey="Bronstein, A M" sort="Bronstein, A M" uniqKey="Bronstein A" first="A M" last="Bronstein">A M Bronstein</name></author><author><name sortKey="Davies, R A" sort="Davies, R A" uniqKey="Davies R" first="R A" last="Davies">R A Davies</name></author><author><name sortKey="Rudge, P" sort="Rudge, P" uniqKey="Rudge P" first="P" last="Rudge">P. Rudge</name></author><author><name sortKey="Thilo, K V" sort="Thilo, K V" uniqKey="Thilo K" first="K V" last="Thilo">K V Thilo</name></author></analytic><series><title level="j">Journal of neurology, neurosurgery, and psychiatry</title><idno type="ISSN">0022-3050</idno><imprint><date when="2002" type="published">2002</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Aged (MeSH)</term><term>Calculi (diagnosis)</term><term>Cerebellar Diseases (diagnosis)</term><term>Diagnosis, Differential (MeSH)</term><term>Female (MeSH)</term><term>Humans (MeSH)</term><term>Labyrinth Diseases (diagnosis)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Neurologic Examination (MeSH)</term><term>Nystagmus, Pathologic (diagnosis)</term><term>Semicircular Canals (MeSH)</term><term>Vertigo (diagnosis)</term><term>Vestibular Function Tests (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Adulte d'âge moyen (MeSH)</term><term>Calculs (diagnostic)</term><term>Canaux semicirculaires osseux (MeSH)</term><term>Diagnostic différentiel (MeSH)</term><term>Examen neurologique (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Maladies du cervelet (diagnostic)</term><term>Maladies labyrinthiques (diagnostic)</term><term>Mâle (MeSH)</term><term>Nystagmus pathologique (diagnostic)</term><term>Sujet âgé (MeSH)</term><term>Vertige (diagnostic)</term><term>Épreuves vestibulaires (MeSH)</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Calculi</term><term>Cerebellar Diseases</term><term>Labyrinth Diseases</term><term>Nystagmus, Pathologic</term><term>Vertigo</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Calculs</term><term>Maladies du cervelet</term><term>Maladies labyrinthiques</term><term>Nystagmus pathologique</term><term>Vertige</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Diagnosis, Differential</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Neurologic Examination</term><term>Semicircular Canals</term><term>Vestibular Function Tests</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Canaux semicirculaires osseux</term><term>Diagnostic différentiel</term><term>Examen neurologique</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Sujet âgé</term><term>Épreuves vestibulaires</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVES</b></p><p>To clarify the clinical significance of positional down beat nystagmus (pDBN).</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>A discussion of the neuro-otological findings in 50 consecutive patients with pDBN.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">11861698</PMID><DateCompleted><Year>2002</Year><Month>03</Month><Day>28</Day></DateCompleted><DateRevised><Year>2019</Year><Month>05</Month><Day>01</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0022-3050</ISSN><JournalIssue CitedMedium="Print"><Volume>72</Volume><Issue>3</Issue><PubDate><Year>2002</Year><Month>Mar</Month></PubDate></JournalIssue><Title>Journal of neurology, neurosurgery, and psychiatry</Title><ISOAbbreviation>J Neurol Neurosurg Psychiatry</ISOAbbreviation></Journal><ArticleTitle>Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.</ArticleTitle><Pagination><MedlinePgn>366-72</MedlinePgn></Pagination><Abstract><AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">To clarify the clinical significance of positional down beat nystagmus (pDBN).</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">A discussion of the neuro-otological findings in 50 consecutive patients with pDBN.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bertholon</LastName><ForeName>P</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>CHU de Saint Etienne, Hopital Bellevue, Saint Etienne, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Bronstein</LastName><ForeName>A M</ForeName><Initials>AM</Initials></Author><Author ValidYN="Y"><LastName>Davies</LastName><ForeName>R A</ForeName><Initials>RA</Initials></Author><Author ValidYN="Y"><LastName>Rudge</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>Thilo</LastName><ForeName>K V</ForeName><Initials>KV</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>MC_U950770497</GrantID><Agency>Medical Research Council</Agency><Country>United Kingdom</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D013485">Research Support, Non-U.S. Gov't</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>J Neurol Neurosurg Psychiatry</MedlineTA><NlmUniqueID>2985191R</NlmUniqueID><ISSNLinking>0022-3050</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002137" MajorTopicYN="N">Calculi</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002526" MajorTopicYN="N">Cerebellar Diseases</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D003937" MajorTopicYN="N">Diagnosis, Differential</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007759" MajorTopicYN="N">Labyrinth Diseases</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009460" MajorTopicYN="N">Neurologic Examination</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009759" MajorTopicYN="N">Nystagmus, Pathologic</DescriptorName><QualifierName UI="Q000175" 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Rudge</name><name sortKey="Thilo, K V" sort="Thilo, K V" uniqKey="Thilo K" first="K V" last="Thilo">K V Thilo</name></noCountry><country name="France"><region name="Auvergne-Rhône-Alpes"><name sortKey="Bertholon, P" sort="Bertholon, P" uniqKey="Bertholon P" first="P" last="Bertholon">P. Bertholon</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:11861698" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a TestDixHallpikeV1
| This area was generated with Dilib version V0.6.37. |  |