Persistent Direction-Fixed Nystagmus Following Canalith Repositioning Maneuver for Horizontal Canal BPPV: A Case of Canalith Jam

• Main Authors: Young-Soo Chang, Jeesun Choi, Won-Ho Chung
• Format: Article
• Language: English
• Published: Korean Society of Otorhinolaryngology-Head and Neck Surgery 2014-06-01
• Series: Clinical and Experimental Otorhinolaryngology
• Subjects: Canalith jam; Benign paroxysmal positional vertigo; Repositioning maneuver
• Online Access: http://www.e-ceo.org/upload/pdf/ceo-7-138.pdf

The authors report a 64-year-old man who developed persistent direction fixed nystagmus after a canalith repositioning maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The patient was initially diagnosed with right HC-BPPV given that the Dix-Hallpike test showed geotropic horizontal nystagmus that was more pronounced on the right side, although the roll test did not show any positional nystagmus. The patient was treated with a canalith repositioning maneuver (Lempert maneuver). The next day, the patient experienced a different character of dizziness, and left-beating spontaneous nystagmus regardless of head position was observed. After a forced prolonged left decubitus and frequent head shaking, his symptoms and nystagmus resolved. This condition, referred to as canalith jam, can be a complication after the repositioning maneuver in patients with BPPV. Atypical positional tests suggest that abnormal canal anatomy could be the underlying cause of canalith jam.