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Persistent direction-changing positional nystagmus

Another variant of benign positional nystagmus?

From the Department of Neurology (Drs. Baloh and Yue) and the Division of Surgery (Head and Neck) (Dr. Baloh, K. Jacobson, and Dr. Honrubia), UCLA School of Medicine, Los Angeles, CA.

Address correspondence and reprint requests to Dr. Robert W. Baloh, Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90024-1769.

Positional nystagmus that does not fatigue, persists as long as the position is held, and changes direction in different head positions has typically been attributed to central vestibular lesions. We recently studied three patients who presented with positional nystagmus having these features but almost certainly of benign peripheral origin. All three had an initial history typical of benign positional vertigo and, in two, the persistent direction-changing positional nystagmus occurred after the patient underwent a maneuver to remove debris from the posterior semicircular canal. The positional nystagmus profile and clinical course are consistent with the debris leaving the posterior semicircular canal and becoming attached to the cupula of the horizontal semicircular canal.

Supported by NICDC grant DC01404 and NIA grant AG09693.

Received October 5, 1994. Accepted in final form November 28,1994.

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