European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2026
Reversible post-head-shaking nystagmus in horizontal canal BPPV as a mechanical mimic of vestibular hypofunction: a case report.
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Ben-Rubi Shimron Hadas, Castellucci Andrea, Gimmon Yoav
Аннотация
PURPOSE: To describe transient post-head-shaking nystagmus associated with horizontal canal benign paroxysmal positional vertigo (BPPV) and its resolution following canalith repositioning.
METHODS: A 78-year-old woman presented with positional vertigo. Video-oculography revealed left-beating pseudo-spontaneous nystagmus and a robust left-beating pHSN, initially suggestive of uncompensated unilateral vestibulopathy. Further bedside assessment, including the Head Pitch test and Supine Roll test, demonstrated direction-changing horizontal nystagmus consistent with left horizontal canalolithiasis.
RESULTS: After an unsuccessful Lempert maneuver, a Gufoni maneuver was performed, resulting in immediate resolution of vertigo and nystagmus. At 10-day follow-up, no spontaneous, positional, or post-head-shaking nystagmus was observed. The patient remained asymptomatic throughout 14-month follow-up, with preserved horizontal vHIT responses at reassessment.
CONCLUSION: This case suggests that post-head-shaking nystagmus in horizontal canal BPPV may arise from transient mechanically triggered asymmetry rather than a fixed vestibular deficit. Reliance on pHSN alone may lead to misdiagnosis and inappropriate diagnostic interpretation. Incorporating positional testing and reassessment following canalith repositioning may help avoid misinterpretation of post-head-shaking nystagmus as unilateral vestibular hypofunction.
METHODS: A 78-year-old woman presented with positional vertigo. Video-oculography revealed left-beating pseudo-spontaneous nystagmus and a robust left-beating pHSN, initially suggestive of uncompensated unilateral vestibulopathy. Further bedside assessment, including the Head Pitch test and Supine Roll test, demonstrated direction-changing horizontal nystagmus consistent with left horizontal canalolithiasis.
RESULTS: After an unsuccessful Lempert maneuver, a Gufoni maneuver was performed, resulting in immediate resolution of vertigo and nystagmus. At 10-day follow-up, no spontaneous, positional, or post-head-shaking nystagmus was observed. The patient remained asymptomatic throughout 14-month follow-up, with preserved horizontal vHIT responses at reassessment.
CONCLUSION: This case suggests that post-head-shaking nystagmus in horizontal canal BPPV may arise from transient mechanically triggered asymmetry rather than a fixed vestibular deficit. Reliance on pHSN alone may lead to misdiagnosis and inappropriate diagnostic interpretation. Incorporating positional testing and reassessment following canalith repositioning may help avoid misinterpretation of post-head-shaking nystagmus as unilateral vestibular hypofunction.