POSITIONING NYSTAGMUS

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Presentation transcript:

POSITIONING NYSTAGMUS

POSITIONING NYSTAGMUS IF THE NYSTAGMUS OCCURS AS A RESULT OF THE HEAD OR HEAD AND BODY MOTION – THE NYSTAGMUS IS SAID TO BE POSITIONING.

BENIGN PAROXYSMAL POSITIONAL VERTIGO /BPPV/ BPPV IS A COMMON INNER EAR DISORDER RE- SULTING FROM ABNORMAL STIMULATION OF THE SCC, USUALLY THE POSTERIOR. THE ABNORMAL STIMULATION IS DUE TO THE PRESENCE OF OTOLITHS MO- VING IN CANAL ENDOLYPH UNDER THE INFLUENCE OF GRAVITY.

ETIOLOGY OF BPPV BPPV IS NOT A DESEASE, BUT RATHER , A SYNDROME THAT CAN BE THE SEQUELA OF SEVERAL INNER EAR DISEASES. IN 2/3 OF THE CASES NO ETIOLOGY CAN BE FOUND.

THE FIRST DISCRIBTION OF THE BPPV THE BASIC FEATURES OF THE BPPV AND THE ASSOCIATED POSITIONING NYSTAGMUS WERE FIRST DESCRIBED IN A SINGLE PATIENT BY BARANY IN 1921. HE SPECULATED THAT THE PAROXYSMAL POSITIONAL NYSTAGMUS WAS CAUSED BY LESION OF THE OTOLITH ORGANS AS IT WAS INDUCED BY A CHANGE IN HEAD POSITION RELTIVE TO GRAVITY.

IN THE 1952 DIX AND HALLPIKE DESCRIBED THE PROVOCATIVE POSITIONING MANEUVER AND CLEARLY DEFINED THE CLINICAL FEATURES OF THE SYNDROME.

CLINICAL FEATURES PATIENTS REPORT ABOUT SHORT EPISODES /SECONDS/ OF STRONG VERTIGO WITH TURNING IN BED, COMING UP AND LYING DOWN, COMING UP AND LYING DOWN, LOOKING UP “TOP SHELF VERTIGO”.

PATHOPHYSIOLOGY PLANATION FOR BPPV THE MOST LIKELY EX- IS CANALITHASIS INVOLVING THE PCC. WITH THE PATIENT SIT- TING UPRIGHT, A CLOT OF CALCIUM CARBO- NATE CRYSTALS FORMS THE MOST DEPENDENT PORTION OF THE PC

MOVEMENT OF THE HEAD BACK AND TO THE SIDE IN THE PLANE OF PCC CAUSES THE CLOT TO MOVE IN THE AMPULLOFUGAL DIRECTION, PRODU- CING AMPULLOFUGAL DISPLACEMENT OF CUPULA, DUE TO THE “PLUNGER” EFFECT OF THE CLOT, MOVING WITHIN THE NARROW CANAL.

TYPICAL CHARACTERISTICS FATIGABILITY WITH REPEATED POSITIONING IS EXPLAINED BY DISPERSION OF THE PARTICLES FROM THE CLOT, MAKING THE PLUNGER EFFECT LESS. THE INDUCED VERTIGO AND NYSTAGMUS ARE BRIEF IN DURATION, BECAUSE CUPULA RETUR- NES TO ITS PRIMARY POSITION. THE LATENCY BEFORE ONESET OF NYSTAGMUS IS EXPLAINED BY THE DELAY IN SETTING THE CLOT INTO MOTION.

NYSTAGMUS EACH SCC HAS A UNIQUE EYE MOVEMENT SIGNATURE WHEN STIMULATED. FOR PSCC THE BEAT OF THE NYSTAGMUS IS PRODUCED BY IPSILATERAL SUPERIOR OBLIQUE AND CONTRALATERAL INFERIOR RECTUS. NYSTAGMUS IS TORSION TO THE SIDE STI- MULATED, HORIZONTAL, AWAY FROM THE STIMULATED SIDE AND UP.

NYSTAGMUS EACH SCC HAS A UNIQUE EYE MOVEMENT SIGNATURE WHEN STIMULATED. FOR PSCC THE BEAT OF THE NYSTAGMUS IS PRODUCED BY IPSILATERAL SUPERIOR OBLIQUE AND CONTRALATERAL INFERIOR RECTUS. NYSTAGMUS IS TORSION TO THE SIDE STI- MULATED, HORIZONTAL, AWAY FROM THE STIMULATED SIDE AND UP.

RECORDING FOR RIGHT POSTERIOR CANAL BPPV DEMONSTRATES UP AND LEFT BEATING NYSTAGMUS.

RT BPPV BLUE – HORIZONTAL EYE PO- SITION, RED – VERTICAL EYE POSITION

LT BPPV RECORDING FOR LT POSTERIOR CANAL BPPV DEMONSTRATES UP AND RT BEATING NYSTAGMUS.

LT BPPV

LT BPPV