Horizontal semicircular canalith jam mimicking acute vestibular syndrome: physiotherapy-guided diagnosis and treatment in three cases.
Background: Canalith jam (CJ) is a rare variant of benign paroxysmal positional vertigo (BPPV), resulting from otoconial obstruction of endolymph flow. It causes persistent, direction-fixed nystagmus (DFN) and can mimic acute vestibular syndrome (AVS), including vestibular neuritis (VN) or stroke. O...
| Published in: | Physiotherapy Theory & Practice Vol. 42; no. 2; pp. 342 - 351 |
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| Main Authors: | , , , , , |
| Format: | case study pictorial tables/charts Journal Article |
| Published: |
Taylor & Francis Ltd
Feb2026
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=191332075&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 191332075 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09593985 BCJ jtl: Physiotherapy Theory & Practice issn: 09593985 maglogo: Y pubinfo: dt: Feb2026 vid: 42 iid: 2 pid: 377 pub: Taylor & Francis Ltd place: Philadelphia, Pennsylvania artinfo: ui: 191332075 188132271 191332075 191332075 10.1080/09593985.2025.2562910 191332075 ppf: 342 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Horizontal semicircular canalith jam mimicking acute vestibular syndrome: physiotherapy-guided diagnosis and treatment in three cases. aug: au: Vats, Ajay Kumar Mohamad, Alfarghal Bijllani, Avinash Rohiwal, Ramesh Vats, Shreya Kothari, Sudhir affil: Department of Medicine and Neurology, Shanti Raj Hospital, Udaipur, India sug: subj: Benign Paroxysmal Positional Vertigo Diagnosis Benign Paroxysmal Positional Vertigo Therapy Semicircular Canals Physiopathology Physical Therapy Methods Middle Age Female Male Physical Examination Flexion Neck Physiology Disease Management Methods Treatment Outcomes Middle Aged: 45-64 years Female Male ab: Background: Canalith jam (CJ) is a rare variant of benign paroxysmal positional vertigo (BPPV), resulting from otoconial obstruction of endolymph flow. It causes persistent, direction-fixed nystagmus (DFN) and can mimic acute vestibular syndrome (AVS), including vestibular neuritis (VN) or stroke. Objective: To describe the clinical and infrared video-Frenzel (IRVF) based diagnosis of horizontal semicircular canal (HSC) canalith jam (HSCCJ), a subtype of CJ, and to highlight the role of physiotherapy-guided bedside maneuvers in its successful management. Case Descriptions: Three patients (aged 50, 55, and 62) presented with positionally triggered acute vertigo. Patients 1 and 3 had sustained DFN consistent with AVS, whereas patient 2 developed persistent DFN during positional testing. The diagnosis of HSCCJ was established through positional tests [supine roll test (SRT), bow and lean test (BLT)] and assessment of DFN using IRVF goggles. Intervention: All patients underwent a physiotherapist-administered head-shaking maneuver (HSM) in the yaw plane, performed with 30° of neck flexion. One patient also received the Gufoni maneuver (GM). Maneuvers were guided by real-time oculomotor responses recorded via videonystagmoscopy. Outcomes: All patients experienced complete resolution of symptoms and nystagmus within 4 hours, confirmed by repeat testing at 4 and 24 hours. Transient nausea and vomiting were the only adverse effects observed. Conclusion: Although the diagnosis of HSCCJ depends on clinical and oculographic evaluation, physiotherapy-guided HSM is a simple, safe, and effective bedside intervention. Incorporating this approach into vestibular rehabilitation (VR) protocols may enhance outcomes in atypical BPPV. pubtype: Academic Journal doctype: case study pictorial tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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