Résumé
El vértigo posicional paroxístico benigno (VPPB) es un síndrome vestibular episódico (SVE) que es reconocido por ser el trastorno más frecuente observado en la clínica, siendo de buena y pronta resolución en la gran mayoría de los casos. Sin embargo, pueden presentarse variantes muy poco habituales o atípicas, donde el canalith jam es una de las formas más resistentes al tratamiento mediante maniobras de reposición, y por lo mismo, el reconocimiento adecuado de este cuadro es esencial para su correcto abordaje. Se presentan dos casos de VPPB con canalith jam en el CSC horizontal y se proponen cinco criterios diagnósticos para su identificación.
Benign paroxysmal positional vertigo (BPPV) is an episodic vestibular syndrome (EVS) that is recognized for being the most frequent disorder observed in the clinic, with good and prompt resolution in the vast majority of cases. However, very unusual or atypical variants can occur, where the canalith jam is one of the forms most resistant to treatment by means of repositioning maneuvers, and for the same reason, the adequate recognition of this condition is essential for its correct approach. Two cases of BPPV with canalith jam in the horizontal semicircular canal and five diagnostic criteria for its identification are presented.
Résumé
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.