, Volume 33, Issue 4, pp 955-956
Date: 05 Nov 2011

Anterior semicircular canal BPPV with positional downbeat nystagmus without latency, habituation and adaptation

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Dear Sir,

A 62-year-old female presented to our emergency room with a 3-day history of positional vertigo on lying down, rising from and turning in the bed. Neurologic examination was normal; there was no spontaneous or gaze-evoked nystagmus. In the right Dix–Hallpike test (DHT), upbeat nystagmus with torsional component was observed, with latency and habituation, and the patient was diagnosed with benign paroxysmal positional vertigo (BPPV) of the right posterior semicircular canal (PC). The Epley maneuver was performed and the patient recovered completely. Four days later she again presented with positional vertigo. Again the neurological examination was normal. This time in the left DHT, down beat nystagmus (DBN) with slight torsional component towards the right ear (Video 1) was observed, without latency, habituation or adaptation. The patient complained of severe vertigo and nausea. Upon returning to the sitting position, a short burst of upbeat nystagmus was observed and the patie ...