Persistent apogeotropic positional nystagmus of the lateral semicircular canal: clinical features and association with vestibular atelectasis on delayed 3D-FLAIR MRI

Persistent apogeotropic positional nystagmus of the lateral semicircular canal, often classified as atypical lateral semicircular canal (SCC) BPPV (alBPPV), may occur without typical positional nystagmus or response to repositioning maneuvers, in the absence of neurological disease....

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Clinicians evaluating persistent apogeotropic lateral canal positional nystagmus should consider delayed 3D-FLAIR MRI to investigate vestibular atelectasis (inner ear fluid sac collapse) as an underlying cause, though this imaging is not yet standard practice and requires specialist access.

Linking a persistent and diagnostically puzzling nystagmus pattern to an identifiable MRI finding (vestibular atelectasis) may open a pathway to targeted management and reduce diagnostic uncertainty in refractory vestibular cases.

1. 01Persistent apogeotropic positional nystagmus of the lateral canal is a refractory balance disorder poorly understood in current practice.
2. 02Delayed 3D-FLAIR MRI (taken hours post-gadolinium injection) can visualize inner ear fluid space abnormalities non-invasively.
3. 03Study finds an association between this nystagmus pattern and vestibular atelectasis (collapse of inner ear membrane structures).
4. 04Findings suggest an endolymphatic hydrops-related (inner ear fluid pressure imbalance) mechanism may be involved.
5. 05Provides a potential imaging biomarker to guide diagnosis and future treatment strategies.

PMID

42630146

DOI

10.3389/fneur.2026.1890082.

Journal

Frontiers in Neurology

Publication type

research_article

Evidence level

4

Population

Patients presenting with persistent apogeotropic positional nystagmus of the lateral semicircular canal

Intervention

Delayed 3D-FLAIR MRI for vestibular atelectasis identification