1. POSITIONING NYSTAGMUS

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

3. 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.

4. 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.

5. 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.

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

7. 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”.

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

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

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

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

16. LT BPPV

17. LT BPPV