Light Cupula: To Be Or Not to Be?


Benign paroxysmal positional vertigo (BPPV) represents the most common form of positional vertigo. It is caused by dislodged otoconia that freely float in the semicircular canals (canalolithiasis) or attach to the cupula (cupulolithiasis). A cupulolithiasis-type (or a heavy cupula-type) of BPPV implicating the lateral semicircular canal (LSCC) exhibits persistent ageotropic direction-changing positional nystagmus (DCPN) in a head-roll test. However, in some cases, unlike any type of BPPV, persistent geotropic DCPN cannot be explained by any mechanisms of BPPV, and don’t fit the current classifications. Recently, the notion of light cupula has been introduced to refer to the persistent geotropic DCPN. In this study, we looked at the clinical features of light cuplula and discussed the possible mechanisms and therapeutic strategies of the condition. The notion of light cupula is a helpful addition to the theory of peripheral positional vertigo and nystagmus.

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Corresponding authors

Correspondence to Su-lin Zhang or Wei-jia Kong.

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The authors declare that they have no conflict of interests.

Additional information

The study was supported by the National Twelfth-Five Year Research Program of China (No. 2012BAI12B02) and the National Natural Science Foundation of China (No. 81873701).

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Zhang, Sl., Tian, E., Xu, Wc. et al. Light Cupula: To Be Or Not to Be?. CURR MED SCI 40, 455–462 (2020).

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Key words

  • positional vertigo
  • direction-changing positional nystagmus
  • light cupula
  • head-roll test
  • null plane
  • lateral semicircular canal
  • ampulla