1/8. Dacryolith formation around an eyelash retained in the lacrimal sac.A dacryolith was discovered in the lacrimal sac during a dacryocystorhinostomy for chronic dacryocystitis in which there was mucocele formation. Morphological examination confirmed the presence of an eyelash at the centre of the stone and electron microscopy demonstrated the presence of fungi (candida sp.) in a matrix which was of markedly vairable morphology. The mechanism by which a hair enters the punctum and passes along the canaliculus may be attributed to the step-like pattern of ridges on the surface of a hair. The directional nature of these ridges dictates preferential movement towards the root end of the hair and prevents movements in the opposite direction.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
2/8. Localizing signs in positional vertigo due to lateral canal cupulolithiasis.BACKGROUND: Different types of benign positional vertigo (BPV) have been recognized. The variant with permanent apogeotropic direction-changing lateral nystagmus in the supine position is particularly difficult to distinguish from central etiologies. OBJECTIVE: To identify clinical features of this variant of BPV, helping to establish its peripheral etiology. methods: In five patients without any evidence of neurologic disease and with this variant of positional vertigo, the behavior of nystagmus as a function of head position in space was studied. RESULTS: In the supine position, a null point for lateral nystagmus was identified, beyond which the nystagmus changed direction. This null point was evident when the head was turned 10 to 20 degrees to the side. In this position, the ipsilateral cupula of the lateral semicircular canal is aligned with the gravity vector. In two of the five patients, a null point was identified in pitch, beyond which the nystagmus reversed direction. This null point corresponds to the head position where the lateral canals are in an earth horizontal plane. CONCLUSION: From the behavior of lateral nystagmus in different head positions, the lateral canal system of the inner ear is shown to be gravity-sensitive and the side on which the cupula is affected can be determined.- - - - - - - - - - ranking = 7keywords = canal (Clic here for more details about this article) |
3/8. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis.OBJECTIVES: To clarify the clinical significance of positional down beat nystagmus (pDBN). methods: A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. RESULTS: In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the arnold-chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two. CONCLUSION: It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.- - - - - - - - - - ranking = 9keywords = canal (Clic here for more details about this article) |
4/8. "Spinolith": case report of a loose body in the spinal canal.STUDY DESIGN: Case report. A hitherto unreported finding of a bony loose body found lying in the spinal canal causing spinal canal stenosis is presented. SUMMARY OF CLINICAL DETAILS: A 68-year-old, fit man presented with a history of progressive neurologic claudication and neurologic deficit in both his lower limbs. Clinical examination revealed excellent range of movements in his lumbar spine and bilaterally normal straight leg raising. He had no significant pain in his back. neurologic examination showed affection of L5 and S1 dermatomes and myotomes bilaterally. magnetic resonance imaging scan showed severe localized lumbar spinal stenosis at L4-L5. In the absence of any obvious pathology on the scan, it was presumed that the stenosis was the result of infolding of the redundant ligamentum flavum. His walking distance and neurologic deficit continued to deteriorate, although sphincters were not involved. He underwent a posterior spinal decompression of L4-L5. On performing the laminectomy an ovoid and well-defined pearly white loose body was discovered lying loose in the spinal canal causing stenosis. Histologically, the loose body consisted of trabecular bone with areas of cartilage. The patient made a speedy recovery after surgery and was back to his previous level of activity within a month. DISCUSSION: Several different types of foreign body have been identified in the spinal canal. However, this case of an autologous loose body in the spinal canal causing symptomatic canal stenosis is unique. Because the authors could not identify the source of this loose body, they have termed it "spinolith."- - - - - - - - - - ranking = 89.041208361432keywords = spinal canal, canal, spinal (Clic here for more details about this article) |
5/8. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.The Canalith Repositioning Procedure (CRP) is designed to treat benign paroxysmal positional vertigo (BPPV) through induced out-migration of free-moving pathological densities in the endolymph of a semicircular canal, using timed head maneuvers and applied vibration. This article describes the procedure and its rationale, and reports the results in 30 patients who exhibited the classic nystagmus of BPPV with Hallpike maneuvers. CRP obtained timely resolution of the nystagmus and positional vertigo in 100%. Of these, 10% continued to have atypical symptoms, suggesting concomitant pathology; 30% experienced one or more recurrences, but responded well to retreatment with CRP. These results also support an alternative theory that the densities that impart gravity-sensitivity to a semicircular canal in BPPV are free in the canal, rather than attached to the cupula. CRP offers significant advantages over invasive and other noninvasive treatment modalities in current use.- - - - - - - - - - ranking = 7keywords = canal (Clic here for more details about this article) |
6/8. Pediatric canaliculitis and stone formation.A 5-year-old girl with a remote history of idiopathic thrombocytopenic purpura presented with a history of partial nasolacrimal duct obstruction unresolved with standard treatments of probing, irrigation, and lacrimal system intubation. Surgical exploration revealed canaliculitis with dacryolith formation within the inferior canalicular system. After punctoplasty and removal of the dacryoliths, the patient had full resolution of symptoms. Although the diagnosis is uncommon in this age group, it should be included in the differential diagnosis of chronic or recurrent pediatric nasolacrimal obstruction.- - - - - - - - - - ranking = 6keywords = canal (Clic here for more details about this article) |
7/8. The mechanics of benign paroxysmal vertigo.Benign paroxysmal vertigo (BPV) is a disorder of the vestibular labyrinth. The clinical features can be explained by an abnormality in the posterior semicircular canal. Under the influence of gravity, a density differential between the endolymph and the cupula will cause displacement of the cupula when changes in head position occur. The presence or absence of fatiguability is a useful test as it helps define etiology, prognosis, and therapy. At the risk of adding yet another classification of nystagmus to the literature, we submit that division of BPV into two types (fatiguable and nonfatiguable) will simplify and rationalize the management of this common complaint.- - - - - - - - - - ranking = 1keywords = canal (Clic here for more details about this article) |
8/8. Repositioning maneuver for benign paroxysmal positional vertigo (BPPV).With vertigo, the symptom of unsteadiness is a common presenting complaint and the etiology protean. However, the specific subset of this patient population with benign paroxysmal positional vertigo (BPPV) is more defined. Cupololithiasis and canalithiasis are perhaps the best known and best described pathologic conditions resulting in vertigo. This condition occurs when otoconia from the utricle are displaced into the Posterior semicircular canal-cupula. The abnormal position of the otoconia often results in a pathological condition. The location of displacement is most often in the posterior semicircular canal. A better understanding of the etiology of BPPV has led to a simple and effective particle repositioning maneuver that allows the practitioner to alleviate vertigo symptoms for most patients using a simple manipulation.- - - - - - - - - - ranking = 3keywords = canal (Clic here for more details about this article) |