The role of the reversed nystagmus during Zuma maneuver in patients treated for geotropic lateral canal benign paroxysmal positional vertigo

• Published in: Journal of the neurological sciences Vol. 434; p. 120160
• Main Authors: Ramos, Bernardo Faria, Cal, Renato, Mangabeira Albernaz, Pedro Luiz, Zuma e Maia, Francisco
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-03-2022
• Subjects: Benign paroxysmal positional vertigo; Benign Paroxysmal Positional Vertigo - therapy; Canalolithiasis; Geotropic nystagmus; Humans; Lateral semicircular canal; Nystagmus, Pathologic - therapy; Nystagmus, Physiologic; Otolithic Membrane; Repositioning maneuvers; Semicircular Canals; Canalolithiasis; Repositioning maneuvers; Lateral semicircular canal; LC; Geotropic nystagmus; BPPV; LC-BPPV; Benign paroxysmal positional vertigo
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2022.120160

The geotropic variant of lateral canal BPPV occurs due to free floating otoconia in the non ampullary arm of this canal. Several repositioning maneuvers were effective to treat patients with this variant. We have previously proposed that the Zuma maneuver, first described for apogeotropic lateral canal BPPV, could also be effective for the geotropic variant as we believe that adopting a single maneuver may help the neurotological clinical practice.
Fifteen patients with geotropic lateral canal BPPV were enrolled and treated with Zuma maneuver. Patients were reevaluated 1 h after a single maneuver.
All patients showed a nystagmus beating to the affected side in step I of Zuma maneuver that reversed its direction in step II. Besides, all patients achieved immediate resolution of vertigo and positional nystagmus after the application of the maneuver.
The reversal of the nystagmus in step II of Zuma maneuver could be considered as a good prognostic indicator of the successful of this maneuver in patients with geotropic lateral canal BPPV. Moreover, despite the small sample of patients, Zuma maneuver was effective on short-term follow up for geotropic LC-BPPV after a single application.
•A single maneuver for both variants of LC-BPPV helps the clinical practice.•Zuma maneuver seems effective for both geotropic and apogeotropic LC-BPPV.•Reversed nystagmus during Zuma maneuver demonstrates a good prognostic indicator.