後半規管BPPV short-arm型が疑われる症例の検討

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  • Cases of the suspected posterior canal short-arm type of benign paroxysmal positional vertigo

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While canalolithiasis is a well known pathophysiology of posterior canal benign paroxysmal positional vertigo (pc-BPPV), there have been a few recent reports of pathophysiological pathways distinct from canalolithiasis (pc-BPPV-ca), including cupulolithiasis (pc-BPPV-cu) and canalolithiasis of the short-arm type (pc-BPPV short-arm-ca). The present study included 39 patients with persistent vertical-torsional nystagmus triggered by the Head positional test, the Head positioning test and the Dix-Hallpike maneuver, suggesting pc-BPPV-cu or pc-BPPV short-arm-ca. The observed positional nystagmus was weakened, and the findings of nystagmus in each head position and the pattern of positional nystagmus were not helpful in discriminating pc-BPPV-cu versus pc-BPPV short-arm-ca. It is known that the right ear is more commonly involved in pc-BPPV-ca, however the left ear was affected significantly more often than the right ear in 39 patients. If detached otoconias from the utricle enter the long-arm of pc-BPPV, the right ear tends to be affected more than the left ear. It is speculated that detached otoconias from the utricle enter the short-arm of pc-BPPV, inducing pc-BPPV short-arm-ca or pc-BPPV short-arm-cu. When a 3D model of the human temporal bone is considered in the supine position, the direction of the pc-short-arm is perpendicular to the direction of gravity whereas in the sitting position, the direction of the pc-short-arm is in line with the direction of gravity. In order for the otoconias to return from the pc-short-arm into the utricle, it appears to be important to place the head in a position 180 degrees opposite to the sitting position.

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