APOGEOTROPIC VARIANT OF HC-BPPV : WHERE ARE THE PARTICLES?

Resumen

Introduction: The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to free floating particles in the anterior arm of the lateral semicircular canal, particles attached to the cupula facing the canal or particles attached to the cupula facing the utricule. Zuma e Maia described a new treatment to both canalithiasis of the anterior arm of the HC or cupulolithiasis of the HC. Objective: We evaluated our patients with Apogeotropic horizontal semicircular canal BPPV using the Zuma's Maneuver and the dynamics of nystagmus during the repositioning of the particles. Methods: Seventeen patients with Apogeotropic HC-BPPV were enrolled and treated with Zuma's Maneuver. During the repositioning of the particles to the utricule, we observed the nystagmus evoked in each position of the maneuver in order to know where the otoliths were probably located. Results: Eight patients, that we assumed to be a canalithiasis of the anterior arm, showed an apogeotropic nystagmus in the first position for less than 1 minute that maintened the same direction in every position of the maneuver. Six patients, that we assumed to be a cupulolithiasis with the particles facing the canal, showed an apogeotropic nystagmus in the first position for more than 1 minute that maintened the same direction in every position of the maneuver. Three patients, that we assumed to be a cupulolithiasis with the particles facing the utricle, showed an apogeotropic nystagmus in the first position for more than 1 minute that changed direction in the second position of the maneuver. Conclusion: Our data suggest that we can assume where the otoliths probably are located observing the pattern of the nystagmus evoked in each position of the Zuma´s maneuver in patients with Apogeotropic HC-BPPV.