Posterior Canal BPPV with Fixation and with Fixation Removed
Creator
Daniel R. Gold, DO
Affiliation
(DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
This is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsional nystagmus (towards the right ear) with minimal upbeat nystagmus. It is important to know that nystagmus of vestibular origin is commonly suppressed by fixation, but this mainly applies to horizontal and vertical components of nystagmus - there is a poor torsional suppression mechanism.
