Physiotherapy-guided management of post-traumatic multicanal benign paroxysmal positional vertigo complicated by canalith jam and cupulolithiasis: a case report.

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and is typically monocanalicular, affecting a single semicircular canal at a time. Multicanalicular involvement, particularly when associated with canalith jam (CJ) or conversion to cupulolithiasis, is rare and poses significant diagnostic and therapeutic challenges.

CASE PRESENTATION: A 76-year-old woman presented with acute positionally triggered vertigo following a mild traumatic brain injury (mTBI) from a road traffic accident (motorbike slip with cranial impact; transient loss of consciousness < a few minutes, no scalp or ear, nose or throat bleeding). Sequential otoneurologic examinations identified canalolithiasis of right posterior semicircular canal (PSC) and bilateral horizontal semicircular canals (HSC). A quick liberatory rotation maneuver successfully resolved right PSC canalolithiasis but precipitated a CJ in right HSC. Subsequent maneuvers confirmed bilateral HSC canalolithiasis, with later conversion of left HSC canalolithiasis to HSC cupulolithiasis. Stepwise treatment utilizing the head-shaking maneuver (HSM), Gufoni (GM), and Zuma maneuvers (ZM) resulted in complete symptom resolution.

CONCLUSION

This case illustrates the dynamic nature of otoconia migration in multicanalicular BPPV following mTBI. It emphasizes the critical role of meticulous sequential otoneurologic testing, physiotherapy-guided repositioning maneuvers, and heightened awareness of CJ as a potential complication of these procedures.