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  • Title: Benign paroxysmal positional vertigo due to a simultaneous involvement of both horizontal and posterior semicircular canals.
    Author: Imai T, Takeda N, Ito M, Nakamae K, Sakae H, Fujioka H, Matsunaga T, Kubo T.
    Journal: Audiol Neurootol; 2006; 11(3):198-205. PubMed ID: 16534183.
    Abstract:
    From April 2001 to November 2003, we investigated 8 patients with benign paroxysmal positional vertigo (BPPV) that was suspected to simultaneously affect both the horizontal and posterior semicircular canals (HSCC and PSCC). These cases showed typical vertical-torsional nystagmus induced by the Dix-Hallpike maneuver, followed by a horizontal nystagmus. They also showed a direction-changing geotropic or apogeotropic positional nystagmus triggered by lateral head rotations in the supine position. Using the three-dimensional analysis of the positional nystagmus, the rotation axis of the positional nystagmus had a component perpendicular to the plane of PSCC and another component perpendicular to the plane of HSCC. All these findings suggest that BPPV in these patients was a combination of posterior and horizontal canal BPPV. The observation of a vertical-torsional positional nystagmus should prompt the specialist to perform not only the canalith repositioning procedure, but also to execute lateral head turns in the supine position.
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