So Young Moon, M.D., Kwang-Dong Choi, M.D., Seong-Ho Park, M.D., Ji Soo Kim, M.D.

Transcription

1 So Young Moon, M.D., Kwang-Dong Choi, M.D., Seong-Ho Park, M.D., Ji Soo Kim, M.D. Background: Benign positional vertigo (BPV) is characterized by episodic vertigo and nystagmus provoked by head motion. Though BPV is the most common cause of vertigo, systemic analysis of clinical features has been sparse. Methods: We analyzed clinical features of 194 patients who had been diagnosed as having BPV in a dizziness clinic from September 2000 to December The diagnosis of BPV was based on the typical nystagmus concurrent with vertigo elicited by positioning maneuvers. The nystagmus was observed by using Frenzel glasses, or recorded with video- or electro-oculography. According to the semicircular canal involved, we classified BPV into posterior, horizontal, and anterior canal types. The horizontal canal type was subdivided into geotropic or apogeotropic. Results: The patients included 149 women and 45 men. Mean age of the patients was 60.9±12.7 with no difference between women and men. Posterior (46.4%) and horizontal (40.7%) semicircular canals were most commonly involved. Most patients were idiopathic. Most patients (97.9%) were successfully treated with canalith repositioning procedure (CRP). Conclusions: BPV may involve each of the three semicircular canals. The involved canal can be identified by careful observation of the nystagmus induced by Hallpike maneuver or head turning in supine position. The horizontal canal is more commonly involved in BPV than previously known. High success rate of CRP is expected only when different method of CRP is applied to each patient depending on the canal involved. J Korean Neurol Assoc 21(6): , 2003 Key Words: Benign positional vertigo, Canalith repositioning procedure 서론 대한신경과학회지 21 권 6 호

2 대상과방법 Figure 1. The Hallpike maneuver of a patient with posterior canal (PC) type of benign positional vertigo (BPV) affecting the left ear. (A) The examiner stands at the patient's left side and rotates the patient's head 45 degrees to the left to align the left PC with the sagittal plane of the body. The examiner moves the patient from the seated to the supine left-ear-down position and extends the patient's neck slightly so that the chin is pointed slightly upward. The latency, duration, and direction of the nystagmus, if present, should be noted. (B) The nystagmus is torsionally upbeating with the torsional component beating to the involved ear. 21 권 6 호대한신경과학회지

3 Figure 2. The positional maneuver used in the diagnosis of horizontal canal benign positiona vertigo (HC-BPV). In supine position, the patient's head is rotated to one side, and then to the other. In geotropic type of HC-BPV (A), the nystagmus beat to the ground while the nystagmus beat to the ceiling in apogeotropic type (B). Figure 3. Electro-oculographic recording of nystagmus in a patient with geotropic type of right horizontal canal benign positional vertigo. The nystagmus is more intense when the head is turned to the involved canal side. 대한신경과학회지 21 권 6 호

4 Figure 4. Left eye vertical electro-oculographic recordings of nystagmus in a patient with anterior canal type of benign positional vertigo. The eye positions of portions in boxes of slow component velocity versus time curves (right column) are figured in right column. The nystagmus can be elicited by straight head hanging and bilateral Hallpike maneuver. Vertical bars and event (evt) in right column curves mark starting and ending points of Hallpike maneuver. The nystagmus is torsional-downbeat with the torsional component beating to the affected ear, irrespective of provoking position. (A) During right Hallpike maneuver, (B) During left Hallpike maneuver, (C) During straight head hanging. 결과 21 권 6 호대한신경과학회지

5 Table 1. Demographic features of BPV (benign positional vertigo) according to each canal type Posterior canal Horizontal canal Apogeotropic Geotropic Anterior canal Mixed type Type p Value Patients, n (%) 90 (46.4) 39 (20.1) 40 (20.6) 12 (8.6) 13 (6.7) 194 (100) Sex, n (%) Female Male 72 (80.0) 18 (20.0) 29 (74.4) 10 (25.6) 27 (67.5) 13 (32.5) 11 (91.7) 1 (8.3) 10 (76.9) 3 (23.1) 149 (76.8) 45 (23.2) 0.35 Age, years Total Female Male 61.9± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± Days prior to visit, d 3.3± ± ± ± ± ± Recurrence history, n (%) 44 (48.9) 21 (53.8) 16 (40.0) 6 (50.0) 9 (69.2) 96 (49.5) 0.51 Values are mean±sd. Table 2. Associated symptoms and disorders of BPV Symptoms Nausea/vomiting Tinnitus Ear fullness headache History Upper respiratory tract infection Migraine Trauma Within 5 days Vestibular neuritis Meniere disease Chronic otitis media BPV; benign positional vertigo. n (%) 97 (50) 38 (19.6) 8 (4.1) 11 (5.7) 46 (23.7) 33 (17.0) 21 (10.8) 3 (1.5) 4 (2.1) 1 (0.5) 1 (0.5) Figure 5. The proportion of each type of benign positional vertigo. The posterior canal and horizontal canals are most commonly involved. HC; horizontal canal, PC; posterior canal, AC; anterior canal. 대한신경과학회지 21 권 6 호

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