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KMID : 1201420110040000060
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Journal of Neurocritical Care
2011 Volume.4 No. 0 p.60 ~ p.67
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How to Do?: Canalith Repositioning Procedures in Benign Paroxysmal Positional Vertigo
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Lee Tae-Kyeong
Park Ji-Yun
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Abstract
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Since Epley first introduced the canalith repositioning procedure (CRP) in 1992, several variations of CRPs treating benign paroxysmal positional vertigo (BPPV) have been employed and the effectiveness has been verified. In addition to CRPs, liberatory maneuvers, habitu-ation exercises, and home self-CRP exercise also demonstrated some clinical effectiveness in managing BPPV. Among them, modified Epley’s maneuver and the Semont’s liberatory maneuver have been found effective for posterior canal BPPV and recommended to be a practice guideline by American Academy of Neurology (AAN). For the horizontal canal BPPV, different strategies should be employed depending on whether the pathology is cupulolithiasis or canalolithiais. Barbecue maneuver, Guffoni’s maneuver or forced prolonged position (FPP) can be chosen for repositioning the free floating canalolithiasis. For the apogeotropic horizontal canal BPPV, same of fore men-tioned CRPs can be applied after liberating the attached otoconia into free floating canalolithiasis using head-shaking or vibration. For the anterior canal BPPV, reversed Epley’s maneuver can be employed. There are some cases of atypical positional vertigo and nystagmus syndrome due to multiple canal involvement or rarely due to central pathology. In those cases, sinister central positional vertigo and nystagmus syndrome should be excluded before doing CRPs and the appropriate CRPs for each type of BPPV must be applied respecti-vely. Although there have been intractable cases to adequate CRPs, removing the improperly positioned otoconia into utricle is the mainstay of managing various BPPVs. In this manuscript, we discuss the exact method and the efficacy of various CRPs
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KEYWORD
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Tuberculous meningitis, Spontaneous regression
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