HIGHLIGHTS
Patients are relieved of benign paroxysmal postural vertigo symptoms after canalith repositioning manuevers however, some may be resistant.
The need for multiple manuevers is more in Fukuda stepping test positive patients.
The recurrence is less in Fukuda stepping test negative patients.
When the Fukuda stepping test is positive, poor prognosis, need for multipl canalith repositioning manuevers and recurrences are expected.
Fukuda stepping test is a valuable bedside test to predict the prognosis of benign paroxysmal postural vertigo.
Abstract
Introduction
Benign paroxysmal postural vertigo originating from the peripheral vestibular system is characterized by brief vertigo spells triggered by the sudden head motion. Usually, vestibular dysfunction in benign paroxysmal postural vertigo is unilateral. Fukuda stepping test which is helpful in the diagnosis of unilateral vestibular dysfunction, may also be valuable in the prediction of prognosis of benign paroxysmal postural vertigo.
Objective
The purpose of this study is to evaluate the relevance of Fukuda stepping test results with resistant and/or recurrent benign paroxysmal postural vertigo cases.
Methods
We evaluated 62 patients with unilateral, idiopathic benign paroxysmal postural vertigo of posterior and/or lateral canals. The Fukuda stepping test was performed prior to the Dix-Hallpike and head-roll tests. Two groups were created according to the Fukuda stepping test results. In Group 1 Fukuda stepping test results were positive with a deviation angle >45°, while in Group 2 the results were negative with no apparent deviation. Two groups were compared by the number of canalith repositioning manuevers performed and the frequency of recurrences.
Results
We found Fukuda stepping test to be invaluable in the diagnosis of benign paroxysmal postural vertigo since the ratio of Fukuda stepping test positivity and negativity were similar in benign paroxysmal postural vertigo patients. However, the need for multiple canalith repositioning manuevers was significantly higher in Group 1 (p= 0.0103). In addition, the recurrence frequency was found significantly lower in the Group 2 (p= 0.0441).
Conclusion
Although the sensitivity of Fukuda stepping test in detecting mild/moderate unilateral vestibular dysfunction is poor, it may be valuable in prediction of the prognosis of benign paroxysmal postural vertigo. We suggest that positive Fukuda stepping test results in benign paroxysmal postural vertigo patients indicate poor prognosis, the need for multipl canalith repositioning manuevers and the higher possibility of recurrences.
Keywords
Intractable vertigo; Fukuda stepping test; Unterberger; Unilateral vestibular dysfunction