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Spontaneous Canalith Jam and Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo

Considerations on a Particular Case Mimicking an Acute Vestibular Deficit

Comacchio, Francesco*; Poletto, Elisabetta; Mion, Marta

doi: 10.1097/MAO.0000000000001949

Objective: Canalith jam refers to a condition caused by an otolithic clump blocked inside a semicircular canal, generally provoked by canalith repositioning procedure. We describe the first case of spontaneous canalith jam mimicking an acute vestibular deficit.

Patient: We report the case of an 82-year-old woman who suffered a sudden episode of persistent rotational vertigo with nausea and vomiting, not provoked by head movements.

Interventions: Videonystagmography revealed a horizontal right-beating spontaneous nystagmus, inhibited by visual fixation. Surprisingly, the positional test showed a direction changing apogeotropic horizontal nystagmus weaker in the left side, compatible with a left side horizontal canal canalolithiasis of the apogetropic type. Returning to the sitting position, a spontaneous nystagmus was observed again, not tilt sensitive. A left side caloric paresis was found.

Results: After performing liberatory maneuvers, the spontaneous nystagmus disappeared and a horizontal canal benign paroxysmal positional vertigo of geotropic type was documented. The canal paresis also disappeared.

Conclusions: Canalith jam is rarely described and is overall observed as a repositioning manoeuvre complication, not as a mimicker of a vestibular neuritis. Furthermore, our case represents the first observation of a recurrent canalith jam and apogeotropic variant of horizontal canal benign paroxysmal positional vertigo.

*Regional Specialized Vertigo Center Veneto Region

Otolaryngology Unit, St. Anthony Hospital

Department of Neurosciences, Institute of Otolaryngology, Padova University, Padova, Italy

Address correspondence and reprint requests to Marta Mion, M.D., Department of Neurosciences, Institute of Otolaryngology, Padova University, Via Nicolò Giustiniani 2, 35121 Padova, Italy; E-mail:

This research was carried out without funding.

The research has been conducted in full accordance with ethical principles.

No conflicts of interest declared.

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