High-resolution three-dimensional magnetic resonance imaging of the vestibular labyrinth in patients with atypical and intractable benign positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a most common cause of dizzi ness and usually a self-limited disease, although a small percentage of pat ients suffer from a permanent form and do not respond to any treatment. Thi s persistent form of BPPV is thought to have a different underlying pathoph ysiology than the generally accepted canalolithiasis theory. We investigate d 5 patients who did not respond to physical treatment, presented with an a typical concomitant nystagmus or both with high-resolution three-dimensiona l magnetic resonance imaging of the inner ear. This method provides an exce llent imaging of the inner ear fluid spaces. In all 5 patients, we found st ructural changes such as fractures or filling defects in the semicircular c anals which we did not find in control groups. One patient clinically prese nted with the symptoms of a 'heavy cupula'. Whereas cross-sections through the ampullary region and the adjoining utricle showed no abnormalities, the re were significant structural changes in the semicircular canals, which ar e able to provide an explanation for the symptoms of a heavy cupula. Copyri ght (C) 2001 S. Karger AG, Basel.