A female patient with a BPPV background successfully treated with maneuvers shows in the previous examination and subsequently a rotatory nystagmus of short duration when performing head thrust. Possible causes?
Torsional nystagmus is commonly associated with posterior canal BPPV. This indicator is not only during dix hallpike, but also during head shaking test.
Its not uncommon to see recurrence of BPPV on follow up visits, .
Our advice is try eppley again and see if patient improves.
Thanks for your answers. Head shaking was always normal, head impulse test not (torsional nystagmus on the left side, the BPPV was on the left too). In the subsequent visit, positional maneuvers where normal, but head impulse test STILL revealed a torsional nystagmus on the left side. What would be the explanation of it?
i understand that you may be performing subjective head impulse test. Normally on head impulse you are expected to see saccades.
I do not know how a stimulation in horizontal plane should lead to torsional nystagmus?. is it possible while performing horizontal head impulse test, posterior canal is also stimulated and responsible for torsional nystagmus?
i advice you to record the duration and adaptability of this along with direction of nystagmus. Perform eppley on left side and see if this solves the problem.
interesting problem statement. Do post , if possible, patient progress, if any.
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