Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss

Andrea Castellucci; Pasquale Malara; Cristina Brandolini; Valeria Del Vecchio; Davide Giordano; Angelo Ghidini; Gian Gaetano Ferri; Antonio Pirodda

doi:10.1016/j.amjoto.2018.12.005

Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss

Am J Otolaryngol. 2019 Mar-Apr;40(2):319-322. doi: 10.1016/j.amjoto.2018.12.005. Epub 2018 Dec 7.

Authors

Andrea Castellucci¹, Pasquale Malara², Cristina Brandolini³, Valeria Del Vecchio³, Davide Giordano¹, Angelo Ghidini¹, Gian Gaetano Ferri⁴, Antonio Pirodda³

Affiliations

¹ ENT Unit, Department of Surgery, Arcispedale Santa Maria Nuova, Azienda USL - Center for Clinical and Basic Research (IRCCS), viale Risorgimento 80, 42123 Reggio Emilia, Italy.
² Audiology & Vestibology Service, Centromedico, Viale Officina 7, 6500 Bellinzona, Switzerland.
³ ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy.
⁴ ENT & Audiology Unit, Department of Experimental Diagnostic and Specialty Medicine (DIMES), S. Orsola - Malpighi University Hospital, Via Massarenti 9, 40138 Bologna, Italy. Electronic address: giangaetano.ferri@unibo.it.

PMID: 30665622
DOI: 10.1016/j.amjoto.2018.12.005

Abstract

Objectives: To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly.

Methods: Case report and literature review.

Results: A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers.

Conclusions: In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.

Keywords: Acute peripheral vestibular loss; Benign paroxysmal positional vertigo; Caloric test; Canalith jam; Horizontal semicircular canal; Video head impulse test.

Publication types

Case Reports
Review

MeSH terms

Acute Disease
Aged
Benign Paroxysmal Positional Vertigo / diagnosis*
Benign Paroxysmal Positional Vertigo / etiology*
Caloric Tests
Diagnosis, Differential
Diagnostic Errors / prevention & control
Female
Humans
Labyrinth Diseases / diagnosis*
Labyrinth Diseases / physiopathology*
Nystagmus, Pathologic / complications*
Nystagmus, Pathologic / diagnosis*
Patient Positioning
Physical Therapy Modalities
Semicircular Canals / physiopathology*
Vestibular Evoked Myogenic Potentials
Vestibular Function Tests
Vestibular Neuronitis / diagnosis*