Review article
Positional and positioning vertigo and nystagmus

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Abstract

Positional and positioning vertigo and nystagmus syndromes can be attributed to either peripheral or central vestibular dysfunction. The most common form is benign paroxysmal positioning vertigo which is caused by cupulolithiasis into the posterior semicircular canal. Other labyrinthine manifestations such as positional alcohol nystagmus, positional nystagmus with macroglobulinaemia and “heavy water” or glycerol ingestion occur because of a specific gravity differential between the cupula and the endolymph (buoyancy mechanism). Neurovascular compression of the vestibular nerve may be a causative factor for “disabling positional vertigo” which is an insufficiently described entity. Hesitation is highly justifiable since retromastoid craniectomy for microvascular decompression is the recommended management. Central positional vertigo is either induced by head movements which result in a transient ischaemia of the ponto-medullary brainstem, or by a change in head position relative to the gravitational vector. The latter is comprised of at least three forms: positional downbeat nystagmus (nodulus), positional nystagmus without concurrent vertigo, and positional vertigo with nystagmus. The site of the lesion is always near the fourth ventricle and the vestibular nuclei. The most probable explanation for the positional response is a vestibular tone imbalance caused by disinhibition of the vestibular reflexes on perception, eye, head and body position.

References (90)

  • R.W. Baloh et al.

    Benign paroxysmal positional nystagmus

    Am. J. Otolaryng.

    (1979)
  • H.O. Barber

    Position nystagmus especially after head injury

    Laryngoscope

    (1964)
  • R. Bárány

    Experimentelle Alkoholintoxikation

    Monatsschr. Ohrenheilk.

    (1911)
  • R. Bárány

    Diagnose von Krankheitserscheinungen im Bereiche des Otolithenapparates

    Acta Otolaryng. (Stockh.)

    (1921)
  • F.O. Black et al.

    Vestibulo-spinal control differs in patients with reduced versus distorted vestibular function

    Acta Otolaryngol. (Stockh.)

    (1984)
  • K.J. Bolch et al.

    Hyperviscosity syndrome associated with immunoglobulin abnormalities

    Semin Hematol.

    (1973)
  • Th. Brandt

    Vertigo and dizziness

  • Th. Brandt et al.

    Physical therapy for benign paroxysmal positional vertigo

    Arch. Otolaryngol.

    (1980)
  • Th. Brandt et al.

    The multisensory physiological and pathological vertigo syndromes

    Ann. Neurol.

    (1980)
  • Th. Brandt et al.

    Postural imbalance with head extension: Improvement by training as a model for ataxia therapy

    Ann. N. Y. Acad. Sci.

    (1981)
  • W. Büchele et al.

    Vestibulo-spinal ataxia in benign paroxysmal positional vertigo

    Aggressology

    (1979)
  • W. Büchele et al.

    Benign paroxysmal positional vertigo and posture

  • W. Büchele et al.

    Vestibular neuritis - a horizontal semicircular canal paresis?

    Adv. Oto-Rhino-Laryngol

    (1988)
  • U. Büttner et al.

    Brainstem auditory-evoked potential abnormalities in vascular malformation of the posterior fossa

    J. Neurol.

    (1983)
  • B. Cohen et al.

    Semicircular canal nerve, eye and head movements: The effect of changes in initial eye and head position on the plane of the induced movement

    Arch. Ophthal. (Chicago)

    (1966)
  • A. DeKleyn et al.

    Untersuchungen über den sogenannten Lagenystagmus während akuter Alkoholvergiftung beim Kaninchen

    Acta Otolaryngol. (Stockh.)

    (1930)
  • D. Denny-Brown

    Recurrent cerebrovascular episodes

    Arch. Neurol.

    (1960)
  • J. Dichgans et al.

    Postural sway in normals and atactic patients: Analysis of the stabilizing and destabilizing effects of vision

    Aggressologie

    (1975)
  • R. Dix et al.

    The pathology, symptomatology and diagnosis of certain common disorders of the vestibular system

    Ann. Otol. Rhinol. Laryngol.

    (1952)
  • J.M. Epley

    New dimensions of benign paroxysmal positional vertigo

    Otolaryngol. Head Neck Surg.

    (1980)
  • J.L. Fahey et al.

    Serum hyperviscosity syndrome

    JAMA

    (1965)
  • C. Fernandez et al.

    Experimental observation on postural nystagmus. II lesions of the nodulus

    Ann. Otol. Rhinol. Laryngol.

    (1960)
  • C. Fernandez et al.

    Experimental cerebellar lesions and their effect on vestibular function

    Acta Otolaryngol.

    (1964)
  • E. Fluur

    Positional and positioning nystagmus as a result of utriculo-cupular integration

    Acta Otolaryngol. (Stockh.)

    (1974)
  • W. Friedman et al.

    Intra-operative brainstem auditory-evoked potentials during posterior fossa microvascular decompression

    J. Neurosurg.

    (1985)
  • R.R. Gacek

    Further observations on posterior ampullary nerve transection for positional vertigo

    Ann. Otol. Rhinol. Laryngol.

    (1978)
  • R.R. Gacek

    Cupulolithiasis and posterior ampullary nerve transection

    Ann. Otol. Rhinol. Laryngol.

    (1984)
  • L. Goldberg et al.

    Criteria of alcohol intoxication in animals in relation to blood alcohol

    Acta Physiol. Scand.

    (1941)
  • W. Graf et al.

    Morpholoy of vertical canal-related second order vestibular neurons in the cat

    Exp. Brain Res.

    (1986)
  • W. Graf et al.

    Morphology of posterior canal-related secondary vestibular neurons in rabbit and cat

    Exp. Brain Res.

    (1983)
  • F.K. Gregorius et al.

    Positional vertigo with cerebellar astrocytoma

    Surg. Neurol.

    (1976)
  • R. Gussen

    Saccule otoconia displacement into cochlea in cochleosaccular degeneration

    Arch. Otolaryngol.

    (1980)
  • F. Harbert

    Benign paroxysmal positional nystagmus

    Arch. Ophthalmol

    (1970)
  • D.G. Hardy et al.

    Microsurgical relationship of the superior cerebellar artery and the trigeminal nerve

    J. Neurosurg.

    (1978)
  • C.S. Harris et al.

    Positional alcohol nystagmus in relation to labyrinthine function

    Naval School of Aviation Medicine, Pensacola

    (1962)
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