Persistent geotropic direction-changing positional nystagmus with a null plane: The light cupula

Authors

  • Chang-Hee Kim MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine
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  • Min-Beom Kim MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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  • Jae Ho Ban MD, PhD

    Corresponding author
    1. Department of Otorhinolaryngology–Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
    • Send correspondence to Jae Ho Ban, MD, PhD, Department of Otolaryngology–Head and Neck Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyoung-Dong Jong-no-Gu, Seoul, Korea 110–746. E-mail: miphy87@naver.com

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  • This study was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science, and Technology (2012R1A1A2044883).

  • The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

The aim of this study was to characterize the clinical features and typical positional nystagmus in patients with persistent geotropic direction-changing positional nystagmus (DCPN) and address the possible pathophysiology of the disease. Furthermore, the proportion of light cupula among the patients showing geotropic DCPN was investigated to assume the incidence of light cupula in those patients.

Study Design

Prospective case series.

Methods

We conducted a prospective case series study in 19 patients with persistent geotropic DCPN. Positional nystagmus during the bow and lean test and the supine head roll test was analyzed using videonystagmography.

Results

All of the 19 patients showed persistent geotropic DCPN without latency. A null plane in which the nystagmus ceases was identified in all of 19 patients, and the intensity of nystagmus was stronger on one side in13 patients (68%) on supine head roll test. Overall, the affected side could be identified in 18 patients (95%). About 14.2% (19 of 134) of patients with geotropic DCPN could be diagnosed as having light cupula in the horizontal semicircular canal.

Conclusions

The patients with light cupula show persistent geotropic DCPN without latency. Affected side(s) can be determined by the direction and intensity of the characteristic positional nystagmus and the side of the null plane. The pathophysiology and treatment of light cupula still remain to be elucidated.

Level of Evidence

4. Laryngoscope, 124:E15–E19, 2014

Ancillary