Clinical and pathogenetic aspects of positional nystagmus

Close metadata

Positional nystagmus (PN) is a heterogeneous clinical phenomenon. Most often it develops in benign positional paroxysmal vertigo as a result of otolithiasis. Rarely PN is observed in cases of lesion location in the cerebellum and brainstem. Recently a theory of light cupula was suggested to explain persisting geotropic PN. It explains the development of nystagmus by the changes in the ratio of the density of cupula to the density of endolymph, making the former sensitive to gravitational forces. Several theories were suggested: lighter cupula theory, heavier endolymph theory, theories of light debris and of density difference between perilymph and endolymph. However, the exact mechanism of light cupula syndrome is unclear. Clear diagnosis of the causes of PN requires detailed evaluation of neurological status with the use of diagnostic tests and additional research methods.

Keywords:

benign paroxysmal positional vertigo

central positional nystagmus

light cupula

endolymph

Authors:

Kutlubaev M.A.

Bashkir State Medical University

SPIN RSCI: 4713-0312
Scopus AuthorID: 9241930700
ORCID: 0000-0003-1001-2024

Received:

16.04.2020

Accepted:

17.04.2020

List of references:

Kutlubaev MA. Benign paroxysmal positional vertigo. Zh Nevrol Psikhiatr im. S.S. Korsakova. 2016;116(3):73-78. (In Russ.). https://doi.org/10.17116/jnevro20161163173-78
Yetiser S. Review of the pathology underlying benign paroxysmal positional vertigo. J Int Med Res. 2019;300060519892370. https://doi.org/10.1177/0300060519892370
Kutlubaev MA, Rakhmatullin AR. The impairment of bone-mineral metabolism in the development of benign paroxysmal positional vertigo. Zh Nevrol Psikhiatr im. S.S. Korsakova. 2019;119(12):139-142. (In Russ.). https://doi.org/10.17116/jnevro2019119121139
Nuti D, Zee DS, Mandalà M. Benign Paroxysmal Positional Vertigo: What We Do and Do Not Know. Semin Neurol. 2020;40(1):49-58. https://doi.org/10.1055/s-0039-3402733
Argaet EC, Bradshaw AP, Welgampola MS. Benign positional vertigo, its diagnosis, treatment and mimics. Clin Neurophysiol Pract. 2019;4:97-111. https://doi.org/10.1016/j.cnp.2019.03.001
Lempert T, von Brevern M. Vestibular Migraine. Neurol Clin. 2019;37(4):695-706. https://doi.org/10.1016/j.ncl.2019.06.003
von Brevern M, Radtke A, Clarke AH, Lempert T. Migrainous vertigo presenting as episodic positional vertigo. Neurology. 2004;62(3):469-472. https://doi.org/10.1212/01.wnl.0000106949.55346.cd
Kutlubaev MA, Pal’chun VT, Savel’eva EE, Guseva AL. Vascular mechanisms in Meniere’s disease. Vestn Otorinolaringol. 2019;84(2):70-77. (In Russ.). https://doi.org/10.17116/otorino20198402170
Joshi P, Mossman S, Luis L, Luxon LM. Central mimics of benign paroxysmal positional vertigo: an illustrative case series. Neurol Sci. 2020;41(2):263-269. https://doi.org/10.1007/s10072-019-04101-0
De Schutter E, Adham ZO, Kattah JC. Central positional vertigo: A clinical-imaging study. Prog Brain Res. 2019;249:345-360. https://doi.org/10.1016/bs.pbr.2019.04.022
Macdonald NK, Kaski D, Saman Y, Al-Shaikh Sulaiman A, Anwer A, Bamiou DE. Central Positional Nystagmus: A Systematic Literature Review. Front Neurol. 2017;8:141. https://doi.org/10.3389/fneur.2017.00141
Choi JY, Kim JH, Kim HJ, Glasauer S, Kim JS. Central paroxysmal positional nystagmus: Characteristics and possible mechanisms. Neurology. 2015;84(22):2238-2246. https://doi.org/10.1212/WNL.0000000000001640
Choi JY, Glasauer S, Kim JH, Zee DS, Kim JS. Characteristics and mechanism of apogeotropic central positional nystagmus. Brain. 2018;141(3):762-775. https://doi.org/10.1093/brain/awx381
Choi JY, Kim JS. Central positional nystagmus: Characteristics and model-based explanations. Prog Brain Res. 2019;249:211-225. https://doi.org/10.1016/bs.pbr.2019.04.012
Laurens J, Angelaki DE. The functional significance of velocity storage and its dependence on gravity. Exp Brain Res. 2011;210(3-4):407-422. https://doi.org/10.1007/s00221-011-2568-4
Aschan G, Stahle J. Nystagmus in Menière’s disease during attacks; a nystagmographical study. Acta Otolaryngol. 1957;47:189-201. https://doi.org/10.3109/00016485709130333
Kim CH, Choi JM, Jung HV, Park HJ, Shin JE. Sudden sensorineural hearing loss with simultaneous positional vertigo showing persistent geotropic direction-changing positional nystagmus. Otol Neurotol. 2014;35:1626-1632. https://doi.org/10.1097/MAO.0000000000000457
Kim CH, Yang YS, Im D, Shin JE. Nystagmus in patients with unilateral acute otitis media complicated by serous labyrinthitis. Acta Otolaryngol. 2016;136:559-563. https://doi.org/10.3109/00016489.2015.1132845
Kim MB, Hong SM, Choi H, Choi S, Pham NC, Shin JE, Kim CH. The Light Cupula: An Emerging New Concept for Positional Vertigo. J Audiol Otol. 2018;22(1):1-5. https://doi.org/10.7874/jao.2017.00234
Hiruma K, Numata T. Positional nystagmus showing neutral points. ORL J Otorhinolaryngol Relat Spec. 2004;66:46-50. https://doi.org/10.1159/000077234
Kim CH, Kim MB, Ban JH. Persistent geotropic direction-changing positional nystagmus with a null plane: the light cupula. Laryngoscope. 2014;124:15-19. https://doi.org/10.1002/lary.24048
Kim CH, Shin JE, Kim YW. A new method for evaluating lateral semicircular canal cupulopathy. Laryngoscope. 2015;125:1921-1925. https://doi.org/10.1002/lary.25181
Ichijo H. Persistent direction-changing geotropic positional nystagmus. Eur Arch Otorhinolaryngol. 2012;269:747-751. https://doi.org/10.1007/s00405-011-1700-1
Hiruma K, Numata T, Mitsuhashi T, Tomemori T, Watanabe R, Okamoto Y. Two types of direction-changing positional nystagmus with neutral points. Auris Nasus Larynx. 2011;38:46-51. https://doi.org/10.1016/j.anl.2010.07.004
Imai T, Matsuda K, Takeda N, Uno A, Kitahara T, Horii A, Nishiike S, Inohara H. Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus. BMJ Open. 2015;5:e006607. https://doi.org/10.1136/bmjopen-2014-006607
Kim CH, Pham NC. Density difference between perilymph and endolymph: A new hypothesis for light cupula phenomenon. Med Hypotheses. 2019;123:55-59. https://doi.org/10.1016/j.mehy.2018.12.017
Money KE, Johnson WH, Corlett BM. Role of semicircular canals in positional alcohol nystagmus. Am J Physiol. 1965;208:1065-1070. https://doi.org/10.1152/ajplegacy.1965.208.6.1065
Money KE, Myles WS. Heavy water nystagmus and effects of alcohol. Nature. 1974;247:404-405. https://doi.org/10.1038/247404a0
Bergenius J, Tomanovic T. Persistent geotropic nystagmus — a different kind of cupular pathology and its localizing signs. Acta Otolaryngol. 2006;126:698-704. https://doi.org/10.1080/00016480500475609
Shigeno K, Egami T, Sasano T. Experimental study of nystagmus induced by injecting various solutions into the middle ear cavity. Acta Otolaryngol. 1989;108:31-37. https://doi.org/10.3109/00016488909107389
Tomanovic T, Bergenius J. Vestibular findings in patients with persistent geotropic positional nystagmus: the ‘light cupula’ phenomenon. Acta Otolaryngol. 2014;134:904-914. https://doi.org/10.3109/00016489.2014.928421
Choi JY, Lee ES, Kim HJ, Kim JS. Persistent geotropic positional nystagmus after meningitis: evidence for light cupula. J Neurol Sci. 2017;379:279-280. https://doi.org/10.1016/j.jns.2017.06.036
Shin JE, Jeong KH, Ahn SH, Kim CH. Conversion between geotropic and apogeotropic persistent direction-changing positional nystagmus. Acta Otolaryngol. 2015;135:1238-1244. https://doi.org/10.3109/00016489.2015.1070965
Kim CH, Shin JE, Shin DH, Kim YW, Ban JH. «Light cupula» involving all three semicircular canals: a frequently misdiagnosed disorder. Med Hypotheses. 2014;83:541-544.
Han K, Lee JY, Shin JE, Kim CH. Positional alcohol nystagmus and serum osmolality: New insights into dizziness associated with acute alcohol intoxication. Med Hypotheses. 2020;138:109606. https://doi.org/10.1016/j.mehy.2020.109606
Tang X, Huang Q, Chen L, Liu P, Feng T, Ou Y, Zheng Y. Clinical Findings in Patients With Persistent Positional Nystagmus: The Designation of «Heavy and Light Cupula». Front Neurol. 2019;10:326. https://doi.org/10.3389/fneur.2019.00326

Close metadata