Discussion
Started 13th Aug, 2022

Torsional nystagmus during head thrust test

A female patient with a BPPV background successfully treated with maneuvers shows in the previous examination and subsequently a rotatory nystagmus of short duration when performing head thrust. Possible causes?

Most recent answer

Suresh Thontadarya
Dr. S. R. Chandrasekhar Institute of Speech and Hearing
i understand that you may be performing subjective head impulse test. Normally on head impulse you are expected to see saccades.
I do not know how a stimulation in horizontal plane should lead to torsional nystagmus?. is it possible while performing horizontal head impulse test, posterior canal is also stimulated and responsible for torsional nystagmus?
i advice you to record the duration and adaptability of this along with direction of nystagmus. Perform eppley on left side and see if this solves the problem.
interesting problem statement. Do post , if possible, patient progress, if any.
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All replies (4)

Suresh Thontadarya
Dr. S. R. Chandrasekhar Institute of Speech and Hearing
Torsional nystagmus is commonly associated with posterior canal BPPV. This indicator is not only during dix hallpike, but also during head shaking test.
Its not uncommon to see recurrence of BPPV on follow up visits, .
Our advice is try eppley again and see if patient improves.
2 Recommendations
Jesús Devesa
Foundation FOLTRA: aimed to the rehabilitation of brain and spinal cord injuries.
I do agree with the response of Suresh.
Thanks for your answers. Head shaking was always normal, head impulse test not (torsional nystagmus on the left side, the BPPV was on the left too). In the subsequent visit, positional maneuvers where normal, but head impulse test STILL revealed a torsional nystagmus on the left side. What would be the explanation of it?
Suresh Thontadarya
Dr. S. R. Chandrasekhar Institute of Speech and Hearing
i understand that you may be performing subjective head impulse test. Normally on head impulse you are expected to see saccades.
I do not know how a stimulation in horizontal plane should lead to torsional nystagmus?. is it possible while performing horizontal head impulse test, posterior canal is also stimulated and responsible for torsional nystagmus?
i advice you to record the duration and adaptability of this along with direction of nystagmus. Perform eppley on left side and see if this solves the problem.
interesting problem statement. Do post , if possible, patient progress, if any.
2 Recommendations

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Is the Sapir-Whorf hypothesis actually a paradox?
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  • Cees Jan MolCees Jan Mol
The Sapir-Whorf hypothesis, also known as (the) linguistic relativity (hypothesis), more or less states (in one of the most specific descriptions by Whorf): users of markedly different grammars are directed by their grammars towards a different evaluation of reality ('Language, Thought and Reality' (selected writings by Benjamin Lee Whorf), 1940: 221).
To my knowledge, research into this hypothesis has to date not touched on the paradox it introduces (and please let me know when I'm mistaken). How is this hypothesis paradoxical?
When someone denies the hypothesis, it means that he or she has arrived at a different evaluation of reality than Whorf, as witnessed by his articulation of the hypothesis. Understanding that Whorf not necessarily meant 'actual wording' by 'grammar' (implying that it's not because those people don't understand the sentence that they reject it), upon asking for clarification of their rejection, they will rationalize their opinion as to why they consider the hypothesis to be wrong. In other words: although in all likeliness expressed in English, their rationalization will reflect an underlying logic different to the one they will say to have read in the hypothesis they rejected. That underlying logic (expressed in a configuration of arguments) will therefore indicate a different 'grammar' which orients the intention of the words they use.
The paradox is that, when people reject linguistic relativity, they can only attempt to make their rejection understood by creating a different grammar intended to persuade their opponents to share their evaluation of reality, not Whorf's. Two grammars, two evaluations of reality (hypothesis is wrong, hypothesis is right). They will, at that point, have paradoxically proven the hypothesis.
Or am I wrong?

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