Falls at advanced age - The importance to search for benign paroxysmal positional vertigo (BPPV).

Abstract

One of the most important geriatric syndromes is dizziness in conjunction with gait disorder and consequent falls. There are various differential diagnoses for dizziness, one of them is benign paroxysmal positional vertigo (BPPV). A targeted diagnostic work-up and treatment of BPPV can prevent subsequent falls and a decline in the patients' quality of life, prolonged hospitalization with unnecessary examinations and medication. Prospective examination of patients with a positive medical history of BPPV. All patients treated within the Department of Geriatrics between 05/2015 and 03/2018 were included. A total of n=5166 patients were screened (n=2651 geriatrics; n=2515 controls). All patients from other wards subjected to a neurological examination due to vertigo served as controls. Patients with typical hints in the medical history for a BPPV were subjected to the diagnostic Dix-Hallpike maneuver and, if positive, subsequent canalith repositioning maneuvers. The percentage of successful positional treatments was determined in both groups. N=254 patients (4.9%) had indications in the medical history for a BPPV. For 71 of n=254 patients (28%; in total 1.4%; mean age: 78.4±12.3years) the diagnosis of BPPV was proven by a positive Dix-Hallpike maneuver. N=39 (54.9%) patients belong to the geriatric group (mean age 82years) and n=32 (45.1%) to the control group (mean age 73.9years). The frequency of BPPV was similar in both groups (1.3-1.5%). In 91.9% of patients the BPPV was localized in the posterior semicircular canal. Up to 93% were asymptomatic after one or repeated canalith repositioning maneuvers. The BPPV should be considered as an important differential diagnosis for geriatric patients with dizziness and falls. After therapeutic repositioning maneuvers most of the patients are asymptomatic. Therefore, targeted screening and therapy ("theragnostic") of BPPV at an advanced age increases diagnostic accuracy and prevents unnecessary examinations, medications and future falls.