Table 1
Clinical summary of patients with positional down beat nystagmus and no CNS disease*
| Patient | Positional findings | |||||||
|---|---|---|---|---|---|---|---|---|
| No | Sex | Age | Symptom (history) | +ve Manoeuvre | Torsion component | Latency, habit | Audiovestibular tests imaging | Diagnosis |
| *The nystagmus was transient—that is, adapted, in all patients. This is some times called positioning rather than positional nystagmus. | ||||||||
| CP, canal paresis on caloric testing in the light, ≥9%; HL, hearing loss; SNHL, sensorineural hearing loss; BPPV, benign paroxysmal positional vertigo (AC, anterior canal; PC, posterior canal); D-H, Dix-Hallpike positional manoeuvre; Habit, habituation,—that is, attenuation of the nystagmus on repeated positional manoeuvres; FU, follow up; +ve manoeuvre, manoeuvres provoking pDBN. | ||||||||
| 1 | M | 47 | Positional vertigo (migraine) | R+L D-H | R shoulder | Latency + | R CP (16%) | R AC BPPV |
| Sagittal | habit | R mild SNHL | FU: remitting | |||||
| Normal CT | Recurrent | |||||||
| 2 | M | 46 | Positional vertigo | Sagittal only | R shoulder on VOG | Latency + habit | Normal Audiovestibular tests | R AC BPPV |
| (not detected clinically) | Normal MRI | FU: persisted | ||||||
| 3 | F | 46 | Positional vertigo (migraine) | R+L D-H | Tors +ve: direction difficult to ascertain | No latency | Normal audiovestibular tests | AC BPPV |
| No full habit | Normal MRI | FU: normal | ||||||
| 4 | M | 62 | Positional vertigo (head trauma) | R+L D-H | R+L PC BPPV followed by pDBN | Latency + habit | Bilateral high frequency SNHL | R+L PC BPPV |
| Normal vestibular tests | (plus pDBN) | |||||||
| Normal MRI | FU: R PC BPPV | |||||||
| 5 | F | 35 | Positional vertigo(PC BPPV) | R, L, R+L PC BPPV or pDBN (without obvious torsional component) | Latency variable | R CP (12%) | AC/PC BPPV | |
| Habit | Normal audio tests | FU: recurrent | ||||||
| Normal MRI | ||||||||
| 6 | F | 68 | Positional vertigo, space phobia (myopathy) | R+L D-H | Not with pDBN but on one occasion: R | Latency + habit | Normal audiovestibular tests | AC BPPV |
| horizontotorsional | MRI: involutional | FU: persisted | ||||||
| 7 | W | 44 | Spontaneous? and positional vertigo | Sagittal only | Not observed | Latency | Normal audiovestibular tests | AC BPPV |
| No habit | Normal MRI | FU: better subjectively | ||||||
| 8 | M | 33 | Positional vertigo (L ear | R+L D-H | Not observed | No latency | L conductive HL | L AC BPPV |
| surgery) | Habit not tested | MRI abnormal middle ear | FU: unchanged | |||||
| 9 | M | 34 | Spontaneous and movement | L D-H | Horizontal L oblique | No latency | L conductive HL | AC BPPV |
| induced vertigo (migraine and L ear surgery) | component | Habit not tested | CT inflammatory petrous bone changes | ?Vestibular migraine | ||||
| FU: improvement | ||||||||
| 10 | F | 78 | Positional vertigo | L D-H (R D-H: eye | Not observed | Latency? | Bilat High Frequency SNHL | AC BPPV |
| closure due to | Habit | Normal vestibular tests | FU: R PC BPPV | |||||
| vertigo) | Normal CT | |||||||
| 11 | F | 53 | Positional and spontaneous | R+L D-H | Not observed | No latency | Micro DBN (fundus) | AC BPPV |
| vertigo (migraine) | Partial habit | Normal Audiovestibular tests | Vestibular migraine | |||||
| Normal MRI | FU: fluctuating | |||||||
| 12 | F | 52 | Spontaneous vertigo+ visual disorder (migraine) | R+L D-H | Not observed | No latency | Normal audiovestibular tests | AC BPPV |
| Habit not tested | Normal CT | Vestibular migraine | ||||||
| No FU | ||||||||
