Paroxysmal Vertigo Research Articles

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia.

ObjectivesVertebrobasilar dolichoectasia (VBD), an elongation and distension of vertebrobasilar artery, may present with cranial nerve symptoms due to nerve root compression. The objectives of this study are to summarize vestibulocochlear manifestations in subjects with VBD through a case series and to discuss the needs of thorough oto-neurotologic evaluation in VBD subjects before selecting treatment modalities.MethodsFour VBD subjects with vestibulocochlear manifestations were reviewed retrospectively. VBD was confirmed by either brain or internal auditory canal magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA). Patient information, medical history, MRI/MRA findings, and audiometry or vestibular function tests were reviewed according to patient’s specific symptom.ResultsOf the four subjects, three presented with ipsilesional sensorineural hearing loss (SNHL), three with paroxysmal recurrent vertigo, and two with typewriter tinnitus. The MRI/MRA of the four subjects revealed unilateral VBD with neurovascular compression of cisternal segment or the brainstem causing displacement, angulation, or deformity of the cranial nerve VII or VIII that corresponded to the symptoms.ConclusionVestibulocochlear symptoms such as SNHL, recurrent paroxysmal vertigo, or typewriter tinnitus can be precipitated from a neurovascular compression of the vestibulocochlear nerve by VBD. Because proper medical or surgical treatments may stop the disease progression or improve audio-vestibular symptoms in subjects with VBD, a high index of suspicion and meticulous radiologic evaluation are needed when vestibulocochlear symptoms are not otherwise explainable, and if VBD is confirmed to cause audiovestibular manifestation, a thorough oto-neurotologic evaluation should be performed before initial treatment.

Correlation analysis of vertigo etiology and age in children

Objective:To study the etiology of vertigo in children and analyze the relationship between the etiology of vertigo and the age category. Method:One hundred and forty-four cases of children with vertigo or dizziness were selected. All patients received the vertigo questionnaire, audiological, vestibular function and other related examinations. JMP 10.0 was used for statistical analysis. Result:Of 144 patients, 17 cases were preschool age (<6 years old), 101 cases were school age (6-12 years old) and 26 cases were puberty (>12 years old). All patients were mainly distributed between 6 and 10 years old. The most common diagnoses was benign paroxysmal vertigo. The second one was vestibular migraine. Incidence rate of the same disease in different ages was also different. Benign paroxysmal vertigo and vestibular migraine in preschool age, school age and puberty accounted for 58.8%, 42.6%, 0 and 0, 17.8%, 30.8%, respectively. Conclusion:Benign paroxysmal vertigo and vestibular migraine were the most common causes of vertigo in children. Prevalence rate and the etiology was various in different ages. Due to the physical and psychological development of children, analyzing the cause of vertigo in children should be fully considered these characteristics.

Betahistine in the Treatment of Peripheral Vestibular Vertigo: Results of a Real-Life Study in Primary Care.

The present research was carried out with the objective to establish the clinical effect and safety of betahistine (48 mg daily), for the management of peripheral vestibular vertigo, in patients treated by primary care physicians in Colombia. An observational prospective cohort study was conducted including patients older than 15 years with clinical diagnosis of peripheral vestibular vertigo who were candidates to be treated with betahistine (48 mg daily). A sample size of 150 individuals was calculated, and weekly follow-ups were planned for 12 weeks. Rotatory movement sensation, loss of balance, and global improvement scale from 0 to 100 points were evaluated. Complete improvement was defined when the patient reached a level of 100 points. We calculated average weekly improvement, cumulative incidence of complete improvement, incidence rate of complete improvement, and the probability of complete improvement as a function of time. After the first week, the average improvement was 56.6 points (95% confidence interval [CI]: 50.4-62.7). At the end of week 12, it was 89.3 points (95% CI: 86.5-92.2). Sixty-one percent of the patients had achieved complete improvement at the end of the second week. After the sixth week, the percentage of cumulative improvement was 72%, and after 12 weeks of follow-up, the cumulative incidence of complete improvement was 73% (95% CI: 65%-80%). Based on the follow-up times, a complete improvement incidence rate of 16 cases per 100 people/week was calculated (95% CI: 13-19). We concluded that Betahistine (48 mg daily) has a positive effect, controlling the symptoms associated with benign paroxysmal vertigo, with an adequate safety profile.

Cognitive impairment in children with CACNA1A mutations.

To describe the clinico-radiological phenotype of children with a CACNA1A mutation and to precisely evaluate their learning ability and cognitive status. Children between the ages of 3 and 18years harboring a pathogenic CACNA1A mutation associated with episodic ataxia, hemiplegic migraine, benign paroxysmal torticollis, benign paroxysmal vertigo, or benign paroxysmal tonic upgaze, were enrolled in this cross-sectional study. Data concerning psychomotor development, academic performance, educational management, clinical examination at inclusion, and brain imaging were collected. Cognitive assessment was performed using age-standardized scales. Eighteen patients (nine males, nine females; mean age at inclusion: 11y 7mo [SD 4y 5mo; range 3y-17y 11mo]) from 14 families were enrolled. Eleven patients displayed the coexistence or consecutive occurrence of more than one type of episodic event. Nine patients exhibited abnormal neurological examination at inclusion. Brain magnetic resonance imaging (MRI) showed cerebellar atrophy in five patients. Psychomotor development was delayed in nine patients and academic difficulties were reported by the parents in 15 patients; nine patients were in special education. Impairment of intellectual function was assessed in six of the 12 patients with interpretable Full-scale IQ scores and was more frequent when cerebellar atrophy was present on MRI. Cognitive impairment is commonly associated with CACNA1A mutations. We suggest that CACNA1A-associated phenotype should be considered a neurodevelopmental disorder. Cognitive disabilities and academic difficulties are common in children with CACNA1A mutations associated with episodic syndromes. Cognitive function ranges from normal to moderate intellectual disorder in wheelchair-dependent children. Patients with vermian atrophy are at a higher risk of cognitive impairment.

A Chair-based Abbreviated Repositioning Maneuver (ChARM) for fast treatment of posterior BPPV.

To assess the effectiveness of a variation of the Epley maneuver, which we have titled "Chair-based Abbreviated Repositioning maneuver (ChARM)", in solving cases of benign positional paroxysmal vertigo (BPPV) of the posterior canal. ChARM addresses multiple issues of highly overloaded medical centers that delay its due and timely resolution. For example it does not necessitate an examination bed/table and requires only a backed chair, and less than 3 min to be performed. In combination with a recently published abbreviated diagnostic maneuver it can solve BPPV cases within few minutes of single medical visit. Patients being diagnosed with posterior BPPV by means of an abbreviated diagnostic maneuver were recruited. Immediately after diagnosis, a single attempt of ChARM was conducted. The patient was followed for 48h and at 1 month after these procedures to assess the persistence of symptomatology. 124 patients were treated with ChARM immediately after diagnosis during their very first medical visit. 92 patients (74.2%) solved their symptomatology completely after a single attempt of ChARM. The absence of symptoms persisted during the 30days of follow-up. ChARM showed high success rates in solving posterior BPPV. The entire diagnostic-treatment procedure takes less than 5min to perform and may allow direct treatment of patients, thereby avoiding unnecessary referrals or full vestibular testing. These abbreviated tools may be particularly useful in primary care settings or heavily overloaded otolaryngology or neurology departments.

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy. The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days. The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831-0.973, p = .008). Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

An analysis of the results of video head impulse test in benign paroxysmal vertigo of childhood

Objective:This study was to analyze the results of video head impulse test (vHIT) of benign paroxysmal vertigo of childhood (BPVC) in order to determine the potential value of vHIT in the diagnosis and treatment for BPVC and to discuss its possible pathogenesis of BPVC. Method:Thirty-six children with BPVC were enrolled. No hearing loss and skull abnormality were found in these children as assessed by pure tone audiometry, acoustic impedance, CT or MRI scan. The vHIT was carried out, and main outcome measures were the gain of vestibulo-ocular reflex, gain asymmetry, and refixation saccades. Eleven healthy children were selected as normal control who came to our hospital for doing a routine checkup and have no history of dizziness. The differences of vHIT results between these two groups were analyzed. Result:①The vHIT results in control group were normal. In all BPVC subjects, abnormalities were detected in 9 patients (25.0%),including vHIT gains decline in 3 patients, abnormal symmetry in 4 patients, and abnormal isolated overt saccades in 2 patients.②The average saccadic gain in different canals of BPVC group was 1.03±0.14, 1.01±0.15, 1.13±0.31, 1.18±0.36, 1.21±0.33, 1.14±0.30 in left horizontal, right horizontal, left anterior, right posterior, right anterior, left posterior canal, respectively; while in normal group, it was 1.14±0.15, 1.18±0.09, 1.16±0.30, 1.18±0.40, 1.34±0.26, 1.30±0.20, respectively. Significant statistical difference was found only in horizontal canals between these two groups (P<0.05). ③Asymmetry of the three pairs of conjugated semicircular canals was 0.04±0.07 (horizontal canal), 0.06±0.04 (left anterior and right posterior canal), 0.06±0.04 (right anterior and left posterior canal) in BPVC group, respectively; while in control group, it was 0.02±0.02, 0.04±0.03, 0.04±0.04,respectively. There was no statistical difference between the two groups (P>0.05). Conclusion:A certain proportion of abnormal peripheral vestibule function in children with BPVC was found. vHIT is a "child friendly," relatively easytouse, and simple tool to evaluate each of the 6 semicircular canals, which may offer some potential clinical information for assessing the vestibule dysfunction for BPVC.

Clinical analysis of benign paroxysmal vertigo of childhood with frequent episodes

Objective To discuss the clinical characteristics of benign paroxysmal vertigo of childhood(BPVC) with frequent episodes, in order to further improve the level of diagnosis and treatment. Methods The clinical data of 25 cases with frequent episodes of BPVC were analyzed retrospectively.All cases were treated with regimen for migraine. Results Aspirin combined with propranolol had the best effect, quick effect, short period of treatment and minimal side effect. Conclusion Aspirin and propranolol are commonly used drugs in the treatment of migraine, which can effectively treat frequent episodes of BPVC, and is economical and practical, and it is conducive to promotion at the grass-roots level.It also confirms the homology of children with benign paroxysmal vertigo and migraine. Key words: Benign paroxysmal vertigo of childhood; Migraine; Aspirin; Propranolol; Treatment effect

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo; A Randomized Clinical Trial

Background: The fastest and safest treatment method of BPPV is repositioning maneuvers. In Iran, this methods are not widely used, and many physicians use medical therapy, despite their side effects, for management of BPPV. Materials and Methods: In this randomized clinical trial patients with BPPV were randomly allocated to Epley repositioning maneuver or Cinnarizine (25mg every 8 hours) for two weeks. The patients were evaluated for symptoms using visual analogue scale (VAS) scoring system before intervention, first and second weeks after intervention. In the second and third visitd the results of hallpike test was recorded for both groups. Results: 43 patients with a mean age of 46.88±11.08 years in two Epley and Cinnarizine group underwent analysis. The mean VAS score for improvement of symptoms after intervention was 1.66±1.06 in Epley and 1.50±0.91 in Cinnarizine group (P=0.57). Conclusion: we found that there is no significant difference between Epley maneuver and Cinnarizine for treatment and controlling symptoms of BPPV.

Comparing the Effects of Epley Maneuver and Cinnarizine on Benign Positional Paroxysmal Vertigo; A Randomized Clinical Trial

Background: The fastest and safest treatment method of BPPV is repositioning maneuvers. In Iran, this methods are not widely used, and many physicians use medical therapy, despite their side effects, for management of BPPV. Materials and Methods: In this randomized clinical trial patients with BPPV were randomly allocated to Epley repositioning maneuver or Cinnarizine (25mg every 8 hours) for two weeks. The patients were evaluated for symptoms using visual analogue scale (VAS) scoring system before intervention, first and second weeks after intervention. In the second and third visitd the results of hallpike test was recorded for both groups. Results: 43 patients with a mean age of 46.88±11.08 years in two Epley and Cinnarizine group underwent analysis. The mean VAS score for improvement of symptoms after intervention was 1.66±1.06 in Epley and 1.50±0.91 in Cinnarizine group (P=0.57). Conclusion: we found that there is no significant difference between Epley maneuver and Cinnarizine for treatment and controlling symptoms of BPPV. [GMJ.2019;8:e866]

Clinical characteristics of benign paroxysmal positional vertigo (DPPG) in perimenopausal women

The article presents the structural features of benign positional paroxysmal vertigo (BPPV) to gender differences in the comprehensive assessment of the epidemiology of vestibular dysfunction in women of perimenopausal period, allowing for flow of advanced reproductive disorders and medical background correction dishormonal states.

Positional Vertigo After Isolated Cerebellar Nodulus Stroke: A Report of 3 Cases

We report 3 cases (69-year-old man, 71-year-old man, and 82-year-old woman) of isolated cerebellar nodulus stroke patients, who presented with positional vertigo alone that lasted only for 2-4 days. Brain magnetic resonance imaging helped diagnosing these cases. Although rare, clinicians should be aware of isolated cerebellar nodulus stroke, when facing with patients with paroxysmal vertigo of acute onset.

Benign Paroxysmal Vertigo of Childhood

AbstractThe aim of the article is to describe a case of benign paroxysmal vertigo (BPV) in childhood. It emphasizes the fact that every dizziness is not vertigo and every vertigo is not benign paroxysmal positional vertigo. BPV in childhood often goes unrecognized. This case report aims at creating awareness about this benign and self-limiting disorder.

Do pre-school episodic syndromes predict migraine in primary school children? A retrospective cohort study on health care data.

To assess the relative risk, predictive value and population attributable risk fraction of pre-school episodic syndromes for later migraine in primary school age children. This retrospective cohort study used health insurance data on 55,035 children born in 2006 with no diagnosis of migraine up to the age of 5 years. The relative risk, probability and population attributable risk fraction of migraine prompting a physician visit at the age of 6-10 years in children with episodic syndromes included in the International Classification of Headache Disorders (benign paroxysmal torticollis, benign paroxysmal vertigo, cyclic vomiting syndrome, recurrent abdominal symptoms and abdominal migraine) and those not included in the International Classification of Headache Disorders (pavor nocturnus, somnabulism and bruxism) diagnosed up to the age of 5 years were determined. The period prevalence of individual episodic syndromes ranged between 0.01% and 1.40%. For episodic syndromes included in the International Classification of Headache Disorders (recurrent abdominal symptoms and abdominal migraine) and for the episodic syndromes not included in the International Classification of Headache Disorders (somnambulism), the risk for later migraine was increased by factors of 2.08, 21.87 and 3.93, respectively. The proportion of risk for migraine in primary school children explained by any episodic syndromes included in the International Classification of Headache Disorders was 2.18% and for any episodic syndromes not included in the International Classification of Headache Disorders it was 0.59%. Several pre-school episodic syndromes are risk factors for migraine in primary school age children. The fraction of migraine in primary school age children explained by prior episodic syndromes, however, is below 3%. A probability to develop primary school age migraine above 50% was only observed for abdominal migraine.

Efficacy of Particle Repositioning Manoeuvres in Benign Positional Paroxysmal Vertigo: A Revision of 176 Cases Treated in a Tertiary Care Centre

Introduction and objectivesBenign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis. MethodsOne hundred and seventy-six patients with a diagnosis of benign paroxysmal positional vertigo were reviewed retrospectively, of whom 150 had vertigo of the posterior canal, 20 had vertigo of the horizontal canal, 3 had vertigo of the superior canal, and 3 had a double vertigo. The Epley manoeuvre was used to treat the posterior and superior canals, and Lempert manoeuvre was used to treat the horizontal canal. An imaging study by nuclear magnetic resonance with gadolin was always used in refractory cases. ResultsThe Epley manoeuvre showed an efficacy of 74.6 and 100% at first attempt for posterior and superior canals respectively. The efficacy of the Lempert manoeuvre for the horizontal canal was 72.72% in the patients with canalolithiasis, and 58.33% in the patients with cupulolithiasis. The treatment of patients with more than one affected canal and a history of surgery in the previous month was more difficult. ConclusionsParticle repositioning manoeuvres show a very high success rate, allowing better results in the treatment of the posterior canal. We need more studies to confirm the suspicion that surgery may be a factor of poorer prognosis.

Benign paroxysmal torticollis of infancy does not lead to neurological sequelae.

To elucidate the natural course of benign paroxysmal torticollis, the relationship of this disorder to migraine and other paroxysmal diseases, and to analyse candidate genes. This was a case series of children with benign paroxysmal torticollis of infancy (BPTI) diagnosed from 1998 to 2005, at Astrid Lindgren Children's Hospital, Stockholm, Sweden. A neurological examination and a formalized motor assessment were performed from 2005 to 2007. At a second follow-up, in 2014 to 2015, the children and their parents were interviewed and candidate genes analysed. The mean age of the eight females and three males included in the second follow-up was 13 years 9 months (SD 2y 2mo). All motor assessments were normal. Five had developed migraine, abdominal migraine, and/or cyclic vomiting. Prophylactic treatment or migraine-specific medication during attacks were not needed. No paroxysmal tonic upgaze, benign paroxysmal vertigo, epilepsy, episodic ataxia, or paroxysmal dyskinesia was reported. Rare genetic variants in CACNA1A and ATP1A2 were found in two children. Five had a family history of migraine. BPTI is transient and does not lead to neurological sequelae. Most children afflicted experience either a mild migraine or no paroxysmal disorder at all in their adolescence. Genetic variants in candidate genes were few, indicating potential genetic heterogeneity. After resolution of their benign paroxysmal torticollis of infancy (BPTI), children display no gross motor delay. Most adolescents who previously had BPTI have not developed migraine. No mutations in candidate genes, known to cause hemiplegic migraine, were found. Associated symptoms are often lacking during episodes of torticollis.

Benign paroxysmal torticollis, benign paroxysmal vertigo, and benign tonic upward gaze are not benign disorders.

Benign paroxysmal torticollis (BPT), benign paroxysmal vertigo (BPV), and benign tonic upward gaze (BTU) are characterized by transient and recurrent episodes of neurological manifestations. The purpose of this study was to analyse the clinical relationships between these syndromes, associated comorbidities, and genetic bases. In this cross-sectional study, clinical data of patients with BPT, BPV, or BTU were collected with a focus on developmental achievements, learning abilities, and rehabilitation. Neuropsychological assessment and genetic testing were performed. Fifty patients (median age at inclusion 6y) were enrolled. Psychomotor delay, abnormal neurological examination, and low or borderline IQ were found in 19%, 32%, and 26% of the patients respectively. Cognitive dysfunction was present in 27% of the patients. CACNA1A gene mutation was identified in eight families, and KCNA1 and FGF14 mutation in one family respectively. The identification of a CACNA1A mutation was significantly associated with BTU (p=0.03) and with cognitive dysfunction (p=0.01). Patients with BPV were less likely to have cognitive dysfunction. Children with BPT, BPV, or BTU are at high risk of impaired psychomotor and cognitive development. These syndromes should not be regarded as benign and should be considered as part of the spectrum of a neurodevelopmental disorder. Patients with benign paroxysmal torticollis (BPT), benign paroxysmal vertigo (BPV), and benign tonic upward gaze (BTU) have an increased risk of psychomotor delay. These patients also have an increased risk of abnormal neurological examination and cognitive dysfunction. Gene mutations, especially in CACNA1A, were identified in 21% of the families. BPT, BTU, and BPV should not be regarded as benign. BPT, BTU, and BPV should be considered as part of the spectrum of a neurodevelopmental disorder.

Episodic syndromes of childhood associated with migraine.

This review covers recent advances in our understanding of episodic syndromes that may be associated with migraine in children and adolescents, as well as what is known about the treatment of these disorders. The episodic syndromes include benign paroxysmal torticollis, benign paroxysmal vertigo, abdominal migraine, and cyclic vomiting syndrome. Infant colic, or excessive crying in an otherwise healthy and well fed infant, may also fit into this category and is included in the appendix section of the most recent edition of the International Classification of Headache Disorders. Episodic syndromes are considered to be early life expressions of migraine in the developing brain. Additional research is needed to determine, which acute and preventive treatments are the most effective in managing these disorders.

Diagnoses of Dizziness- and Vertigo-related Disorders in ENT Practices in Germany.

The aim of this study was to analyze the prevalence of dizziness- and vertigo-related diagnoses in ear, nose, and throat (ENT) practices in Germany and the associated demographic characteristics based on data from a representative nationwide practice database. The study sample included patients from 138 ENT practices in Germany who received dizziness- and vertigorelated diagnoses (ICD-10 code) between January 2012 and December 2015. Collected parameters included age, sex, insurance status, prescribed medication (anatomical therapeutic chemical [ATC] class), and referrals to other specialists and hospitals. A total of 107,458 patients were available for analysis. Most common diagnoses were "dizziness and giddiness" (67.7%), "benign paroxysmal vertigo" (10.2%) and "disorder of vestibular function, unspecified" (7.2%). Referrals and admissions were made in 12.8%, mostly to radiologists (7.7%), followed by neurologists (3.7%), and hospitals (1.4%). Most referrals were made for unspecific diagnoses and for "vestibular neuronitis." The rate of medical prescriptions was 37.3%, with the most common prescription being for antivertigo preparations. Dizziness- and vertigo-related disorders are frequently diagnosed in ENT practices in Germany. The majority of these diagnoses are unspecific and lead to an increased rate of referrals and hospital admissions. The medical prescription rate, especially of antivertigo preparations, was high, even among patients with benign paroxysmal positioning vertigo. This study reflects a mostly pragmatic approach to a complex diagnostic and therapeutic challenge in daily ENT practice as well as the limited ability of the ICD-10 system to classify the underlying etiology.

Benign paroxysmal migraine variants of infancy and childhood: Transitions and clinical features.

Migraine variant disorders of childhood include benign paroxysmal torticollis of infancy (BPTI) and benign paroxysmal vertigo of childhood (BPVC). This study aimed to review our experience with BPTI and BPVC and determine the incidence of children transitioning between each of these disorders and to vestibular migraine (VM). We retrospectively reviewed the medical records of patients seen at the Balance and Vestibular Program at Boston Children's Hospital between January 2012 and December 2016 who were diagnosed with BPTI, BPVC, and/or VM. Fourteen patients were diagnosed with BPTI, 39 with BPVC, and 100 with VM. Abnormal rotary chair testing was associated with progression from BPTI to BPVC (n=8, p=0.045). Eight (57.1%) patients with BPTI and 11 (28.2%) with BPVC had motor delay. Eleven (78.6%) patients with BPTI and 21 (53.8%) with BPVC had balance impairment. Six BPTI patients developed BPVC (42.9%), six BPVC patients developed VM (15.4%), and two patients progressed through all three disorders (2%). One BPTI patient progressed directly to VM. Most patients with BPTI will experience complete resolution in early childhood, but some will progress to BPVC, and similarly many patients with BPVC will progress to VM. Parents of children with these disorders should be made aware of this phenomenon, which we refer to as "the vestibular march." Children with BPTI and BPVC should also be screened for hearing loss, otitis media, and motor delay.