Persistent Dizziness Research Articles

A Scoping Review on Vestibulopathy After Microsurgical Resection of Vestibular Schwannoma—The Forgotten Symptom

BACKGROUND AND OBJECTIVES: Although half of patients with vestibular schwannoma (VS) experience some form of vestibular dysfunction, it is rarely the most prominent symptom. The effect of VS resection on preexisting vestibulopathy remains poorly understood. Our objective was to perform a scoping review to elucidate the incidence and role of postoperative vestibulopathy after microsurgery (MS) as it relates to long-term quality of life (QOL) and predictors of recovery and to identify optimal management of vestibulopathy as a presenting symptom. METHODS: Studies were identified using the PubMed database published in the English language peer-reviewed recent literature (2000-2023) using MeSH and tiab terms, and additional studies identified from a secondary review of reference lists. RESULTS: Thirty-one articles were selected and reviewed. The literature quotes a wide range for the incidence of postoperative vestibulopathy after MS (4%-100%). Persistent vertigo universally demonstrates a strong negative effect on long-term QOL. Potential predictors of poor vestibular compensation include sex, advanced age, and tumor size. Few studies examine postoperative vertigo compared with preoperative baseline. Studies are inconsistent and variable in their use of measurement tools to assess vestibulopathy and QOL. Improvement in baseline vestibulopathy can be seen in long-term post-MS, particularly in patients with severe or disabling vertigo, although outcomes relative to other treatment modalities are otherwise similar. CONCLUSION: Further understanding of predictors and comparative management strategies for vestibulopathy would be valuable in addressing an important negative influence on QOL in patients with VS. Prospective studies factoring preoperative baseline and using standardized measurement tools are needed.

Graviception Uncertainty, Spatial Anxiety, and Derealization in Patients with Persistent Postural-Perceptual Dizziness

Objectives: Persistent Postural-Perceptual Dizziness (PPPD) is a frequent diagnosis in patients with chronic dizziness, ineffective postural control, visual dependence, and emotional symptoms. Methods: 53 patients with PPPD (25–84 years old) and 53 adults (29–84 years old) with no vestibular disease agreed to participate in this study. Assessments included: vestibular function tests (sinusoidal yaw rotation and vestibular-evoked myogenic potentials); accuracy and precision of Subjective Visual Vertical (SVV) estimation while static and during on-axis yaw rotation; static posturography with open/closed eyes and 30° neck extension, while standing on hard/soft surface; questionnaires on symptoms of unsteadiness, spatial anxiety, dizziness-related handicap, anxiety/depression, depersonalization/derealization, and perceived stress. After preliminary bivariate analyses, analysis of covariance was performed on the measurements of postural sway, spatial anxiety, and dizziness-related handicap (p < 0.05). Results: Higher intraindividual variability (reduced precision) on SVV estimations was evident in patients with PPPD compared to adults with no vestibular disease, which was related to the length of postural sway, to velocity displacement in the sagittal plane, as well as to spatial anxiety and common mental symptoms (including depersonalization/derealization symptoms). Covariance analysis showed contribution of these factors to the dizziness-related handicap reported by the patients. Conclusions: Unprecise graviception could be a contributing factor to the postural instability and mental symptoms reported by patients with PPPD, which in turn contribute to their dizziness-related handicap.

Improvement in Persistent Post-Concussive Symptoms After Treatment with Neuromodulation: A Case Study

AbstractUp to 30% of youth with concussion experience persistent post-concussive symptoms (PPCS) impacting cognitive, social, mental, and physical health. Limited evidence-based therapies exist to treat PPCS. We present a case of an adolescent female with multiple sports-related concussions with persistent symptoms, including headache, nausea, dizziness, brain fog, and anxiety. After 4 weeks of treatment with an auricular percutaneous electrical nerve field stimulation (PENFS) device, she had near-complete resolution of her symptoms, allowing a return to her previous level of academic achievement, as well as physical activity. Emerging evidence suggests that various forms of neuromodulation, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can benefit patients with post-concussive symptoms. This adolescent female’s improvement with PENFS contributes to this expanding field.

Repetitive transcranial magnetic stimulation as add-on therapy in persistent postural-perceptual dizziness

BackgroundThis study aims to evaluate the clinical effectiveness of repetitive transcranial magnetic stimulation (rTMS) when used as an add-on therapy for individuals with persistent postural-perceptual dizziness (PPPD). MethodsIn this randomized controlled, double-blind trial conducted at Shangluo Central Hospital, patients with PPPD diagnosed in the neurology departments were included. Participants were randomized into a rTMS treatment group and a control group in a 1:1 ratio by the randomized grouping method. Patients in both groups received conventional treatment, with the rTMS treatment group underwent daily rTMS sessions, whereas the control group received sham rTMS treatments following the same schedule. The effectiveness of the treatments was primarily assessed using the Dizziness Handicap Inventory (DHI), Hamilton Anxiety Rating Scale (HAMA), and Hamilton Depression Rating Scale (HAMD), which measured symptoms of vertigo, anxiety, and depression at baseline, after two weeks, and at the end of four weeks. FindingsOf the 46 participants recruited, 2 were excluded due to contraindications, 22 were randomly assigned to the rTMS treatment group, and 22 were assigned to the control group. Ultimately, 2 withdrew for personal reasons, and data from 42 participants were included in the outcome analysis. HAMA, HAMD and DHI scores were significantly lower in the rTMS treatment group than in the control group after 4 weeks of treatment (p<0.05). A positive correlation was also observed between DHI scores and HAMA or HAMD scores. ConclusionsThis pilot study demonstrated that rTMS is a beneficial add-on therapy for patients with PPPD.

Addressing the Overlapping Challenges of Benign Paroxysmal Positional Vertigo (BPPV) and Persistent Postural-Perceptual Dizziness (PPPD): Impacts and Integrated Management.

Benign paroxysmal positional vertigo (BPPV) and persistent postural-perceptual dizziness (PPPD) are challenging vestibular disorders with overlapping symptoms that complicate diagnosis and treatment. BPPV causes transient vertigo with head movements, while PPPD involves persistent dizziness and unsteadiness. Both significantly impact the quality of life, including emotional well-being. This review examines the relationship between BPPV and PPPD, stressing the need for comprehensive, multidisciplinary management. Effective treatment must address both physical and psychological aspects, using personalized care, technological innovations, and patient education to improve outcomes and enhance the quality of life for those affected.

Humoral serotonin and neuropsychological status of patients with dizziness

Dizziness is often accompanied by affective disorders such as anxiety and depression, in the occurrence of which the role of the serotonergic system is discussed.Objective: to investigate the serotonin content in blood serum and neuropsychological status in patients with vestibular and non-vestibular dizziness.Material and methods. The study included 97 patients. Two observation groups were formed according to the type of dizziness complaints. The first group (n=47) comprised patients with vestibular (systemic) dizziness against a background of peripheral vestibulopathy, the second group (n=35) comprised patients with non-vestibular (non-systemic) dizziness with a diagnosis of probable persistent postural-perceptual dizziness (PPPD). The control group (n=15) consisted of patients without complaints of dizziness. Neurological and otoneurological status, psychoemotional parameters (level of anxiety and depression) and cognitive functions were analyzed, and the quantitative level of serotonin in blood serum was determined by enzyme immunoassay.Results. The study revealed a significant decrease in the serum serotonin levels in vestibular and non-vestibular dizziness; a lower serotonin level was found in non-vestibular dizziness (p&lt;0.05). The presence of affective disorders did not correlate with a decrease in serotonin levels in vestibular dizziness against a background of peripheral vestibulopathy. It is assumed that a decrease in serotonin content plays a role in pathogenesis of vestibular dizziness on the background of peripheral part of vestibular system involvement.Conclusion. We demonstrated possibility of using the level of serotonin in peripheral blood as an objective laboratory marker of vestibular and non-vestibular dizziness in general clinical medical practice.

Evidence of Peripheral Vestibular Impairment Among Adults With Chronic Moderate-Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is a leading cause of death and disability among adults in the United States. There is evidence to suggest the peripheral vestibular system is vulnerable to damage in individuals with TBI. However, there are limited prospective studies that describe the type and frequency of vestibular impairment in individuals with chronic moderate-severe TBI (> 6 months postinjury). Cervical and ocular vestibular evoked myogenic potentials (VEMPs) and video head impulse test (vHIT) were used to assess the function of otolith organ and horizontal semicircular canal (hSCC) pathways in adults with chronic moderate-severe TBI and in noninjured comparison (NC) participants. Self-report questionnaires were administered to participants with TBI to determine prevalence of vestibular symptoms and quality of life associated with those symptoms. Chronic moderate-severe TBI was associated with a greater degree of impairment in otolith organ, rather than hSCC, pathways. About 63% of participants with TBI had abnormal VEMP responses, compared to only ~10% with abnormal vHIT responses. The NC group had significantly less abnormal VEMP responses (~7%), while none of the NC participants had abnormal vHIT responses. As many as 80% of participants with TBI reported vestibular symptoms, and up to 36% reported that these symptoms negatively affected their quality of life. Adults with TBI reported vestibular symptoms and decreased quality of life related to those symptoms and had objective evidence of peripheral vestibular impairment. Vestibular testing for adults with chronic TBI who report persistent dizziness and imbalance may serve as a guide for treatment and rehabilitation in these individuals.

Prevalence and Clinical Characteristics of Persistent Postural Perceptual Dizziness (PPPD) in South Indian Population: A Preliminary Cross-Sectional Study

Prevalence and Clinical Characteristics of Persistent Postural Perceptual Dizziness (PPPD) in South Indian Population: A Preliminary Cross-Sectional Study

8191 Navigating The Maze Of Adrenal Insufficiency, A Complex Case Of Late Presentation

Abstract Disclosure: K.N. Pereira: None. V. Sundaram: None. V. Mehta: None. K. Desai: None. B. Agrawal: None. Adrenal insufficiency, a rare but potentially life-threatening endocrine disorder, arises from the inadequate production or ineffective response to adrenal hormones, particularly cortisol and aldosterone. It poses diagnostic challenges, especially in individuals with intricate medical histories and manifests as either primary (Addison's disease) or secondary. The subtlety of initial symptoms often leads to a delayed diagnosis, emphasizing the importance of a high index of suspicion among healthcare providers. Timely recognition and intervention are crucial to prevent adrenal crises, which includes severe hypotension, electrolyte imbalances and life-threatening complications. This case report delves into the presentation, diagnosis, and management of primary adrenal insufficiency in a 51-year-old female with a myriad of co-morbidities who presented with persistent low blood pressure, syncope episodes and dizziness both at rest and with exertion, despite being on midodrine with systolic blood pressure readings ranging from 60s to 80s mmHg. She was also noted to be bradycardic and laboratory results showed hyponatremia, hyperkalemia, hypoglycemia and anemia. She was given prompt fluid resuscitation, stress dose steroids and fludrocortisone, leading to a remarkable improvement in blood pressure and overall clinical status. Subsequent testing showed low serum cortisol level and elevated ACTH level, confirming the diagnosis of primary adrenal insufficiency. Continued steroids resulted in significant symptomatic improvement and with no further episodes of hypotension or syncope on ensuing follow ups. This case serves as a poignant illustration for the need for a heightened clinical suspicion, as the symptoms of adrenal insufficiency can often masquerade within the intricate tapestry of comorbidities. When the utilization of midodrine, aimed at managing orthostatic hypotension, did not abate symptoms, it prompted a thorough investigation into the possibility of underlying adrenal dysfunction. This case also highlights the collaborative, multidisciplinary approach in the management of adrenal insufficiency, with endocrinology playing a pivotal role. Presentation: 6/1/2024

Analysis of Quantitative Electroencephalogram Characteristics in Patients with Persistent Posture-Perceived Dizziness

Analysis of Quantitative Electroencephalogram Characteristics in Patients with Persistent Posture-Perceived Dizziness

Cisplatin vestibulotoxicity: a current review.

Cisplatin, a commonly used chemotherapy drug, is well-established for its ototoxic effects, primarily attributed to the damage it inflicts on cochlear hair cells. However, its impact on the vestibular system remains inadequately understood. Here, we provide a comprehensive review of existing literature concerning cisplatin-induced vestibulotoxicity. Animal studies have shown that cisplatin induces a vestibular hair cell loss that is dose-dependent, with the severity of damage also varying according to the route of administration. Notably, intratympanic and systemic injections in animal models have manifested significant damage primarily to utricular hair cells, with a lesser degree of damage observed for the other vestibular end organs. The underlying mechanisms of cisplatin induced vestibular hair cell loss include apoptosis, oxidative stress, and inflammatory cytokines. Several protective agents, such as Pifithrin-α, DAPT, Ginkgolide B, and heat shock proteins, have demonstrated efficacy in inhibiting cisplatin-induced vestibular damage in preclinical studies. Human clinical findings indicate that cisplatin treatment can cause vestibular dysfunction, characterized by symptoms ranging from transient dizziness to persistent vertigo. Challenges in diagnosis, including the limited utilization of comprehensive vestibular testing for many patients, contribute to the variability in reported outcomes. Cisplatin-induced vestibulotoxicity is a significant complication of chemotherapy, necessitating further research to understand its mechanisms and to improve diagnosis and management, ultimately aiming to enhance the quality of life for cancer patients undergoing cisplatin therapy.

Basilar Artery Tortuosity Increases the Risk of Persistent Dizziness and Unsteadiness After Posterior Circulation Infarction.

Basilar artery (BA) tortuosity is closely associated with posterior circulation infarction (PCI) and dizziness/unsteadiness. This study aims to determine the relationship between BA tortuosity and the outcome of dizziness and unsteadiness in PCI patients. This study prospectively recruited PCI patients presenting with dizziness and unsteadiness. BA tortuosity was diagnosed based on Smoker's criteria. The BA tortuosity index (BATI) was measured from magnetic resonance angiography (MRA) images. Posterior circulation was divided into proximal (medulla oblongata and posterior inferior cerebellar), middle, and distal territories. Symptoms, risk of falls, and quality of life were followed up in 3 months after stroke. Logistic regression was used to identify possible factors associated with the persistence of dizziness and unsteadiness. Among 182 PCI patients presenting with dizziness and unsteadiness, 97 (53.3%) had BA tortuosity, including 19 (10.4%) with moderate-to-severe BA tortuosity. At the 3-month follow-up, 58 (31.9%) patients continued to experience dizziness and unsteadiness, with significantly decreased quality of life and a high risk of falls. Binary logistic regression analysis identified moderate-to-severe BA tortuosity (OR, 4.474; 95% CI, 1.591-12.579; p = 0.004) and lesions involving the proximal posterior circulation territory (OR, 2.146; 95% CI, 1.097-4.199; p = 0.026) as risk factors for persistent dizziness and unsteadiness after PCI, while thrombolysis (OR, 0.280; 95% CI, 0.079-0.992; p = 0.049) as a protective factor. BATI (OR, 1.072; 95% CI, 1.028-1.119; p = 0.001) was also independently associated with dizziness and unsteadiness after PCI. Prominent BA tortuosity increases the risk of persistent dizziness and unsteadiness after PCI, leading to a high risk of falls and decreased quality of life. This warrants more attention in clinical practice.

Abstract C036: Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with breast cancer

Abstract Background: Patients with breast cancer face many health issues during the cancer care continuum. Chemotherapy and radiotherapy can cause hearing and balance problems, e.g., tinnitus, hearing loss, and vertigo or persistent dizziness, negatively affecting patients’ health outcomes and quality of life. Hearing loss is more prevalent among cancer survivors than in the general population. However, little attention has been paid to tinnitus, hearing loss, and vertigo specifically among breast cancer patients and survivors, and it is unclear whether these symptoms vary across racial/ethnic groups. Methods: Between July and September 2023, we surveyed patients enrolled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort about whether they experienced tinnitus, hearing loss, and/or vertigo. Racial/ethnic groups included Asian or Pacific Islander (API), Black, Hispanic, and White. To examine racial/ethnic differences in hearing and balance problems, we fit separate multivariable logistic regression models, controlling for sociodemographic and clinicopathologic factors. Adjusted odds ratios (AOR) and 95% CIs were calculated. Results: Of 1,462 patients, the mean age was 54.2 years (SD 11.4), with a median duration from diagnosis to survey of 8.2 years (IQR: 5.0-12.4). Most were White (69.8%), followed by Black (22.7%), API (3.8%), and Hispanic (3.7%); and 46.0% received chemotherapy. Overall, 15.1%, 13.6%, and 7.7% reported experiencing tinnitus, hearing loss, and vertigo, respectively. Similar prevalences of these symptoms were observed among survivors who had received chemotherapy. By race/ethnicity, 16.1% of Black patients reported experiencing tinnitus compared to 15.6% of White, 9.4% of Hispanic, and 3.8% of API patients (P=.050). White patients reported a higher proportion of hearing loss (15.5%) than Hispanic (14.8%), Black (8.0%), and API (7.8%) patients (P=.004). A higher percentage of Black patients (13.2%) reported experiencing vertigo than White (6.5%), Hispanic (5.7%), and API (1.9%) patients (P=.001). After adjusting for demographic and clinical characteristics, Black patients had lower odds of experiencing hearing loss than White patients (AOR 0.39, 95% CI: 0.20-0.75). Compared with White patients, Black patients had greater odds of experiencing vertigo (AOR 1.80, 95% CI: 1.01-3.21). Due to limited power, we did not observe statistically significant differences in vertigo or hearing loss between API or Hispanic survivors and White survivors and in tinnitus across racial/ethnic groups. Older age and longer duration from diagnosis to survey were associated with greater odds of tinnitus or hearing loss. Conclusions: In this multiethnic cohort, hearing and balance problems were prevalent and varied by race/ethnicity among breast cancer patients. Our findings suggest that oncology programs should consider routine screening for these symptoms, encourage patient-provider discussion to identify unmet needs, and address racial/ethnic disparities to improve hearing and balance-related quality of life of breast cancer survivors. Citation Format: Jincong Q. Freeman, Fangyuan Zhao, Wenji Guo, Rita Nanda, Olufunmilayo I. Olopade, Jayant M. Pinto, Megan J. Huisingh-Scheetz, Dezheng Huo. Prevalence of and racial/ethnic differences in hearing and balance problems in a multiethnic cohort of patients with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C036.

VHIT and fHIT in Patients With Migraine, Vestibular Migraine, and Persistent Postural-Perceptual Dizziness.

Impairment in the integration of different vestibular stimuli is the proposed mechanisms in vestibular migraine (VM). In this study, it was aimed to assess the vestibulo-ocular reflex (VOR) and dynamic visual acuity (DVA) in patients with VM and to compare the results with migraine without vestibular symptoms (MwoV), and persistent postural-perceptual dizziness (PPPD) to find out if there are discriminative differences and search for a correlation with the levels of anxiety. Twenty-two patients with MwoV, 23 patients with VM, 22 patients with PPPD, and 23 healthy controls (HC) were studied. Video head impulse test (vHIT) and functional head impulse test (fHIT) without and with an optokinetic background (OB) were performed. Percentage of correctly identified optotypes (CA%) was considered for the fHIT test. Beck anxiety inventory (BAI) was used to assess anxiety. Lateral canal vHIT gain of the patient groups were not different from the healthy controls (p > 0.05). fHIT and fHIT/OB CA% results of all patient groups were lower than the HC (p < 0.005), and VM patients had the lowest scores for both tests. BAI scores of the PPPD patients were the highest and a correlation between anxiety levels, and fHIT results could not be identified (p > 0.05). Prominent CA% drop by the use of an OB was the main finding in patients with VM. This discriminative feature was not correlated with anxiety scores. Difficulty in resolving the conflict between visual and vestibular inputs seem to be the underlying mechanism. 3 Laryngoscope, 2024.

Outcomes After Exoscopic Versus Microscopic Ossicular Chain Reconstruction.

To analyze the outcomes of exoscopic versus microscopic ossicular chain reconstruction (OCR). Retrospective chart review. Tertiary care otology-neurotology practice. Adult subjects with a diagnosis of ossicular discontinuity from 2018 to 2022. Exoscopic or microscopic primary OCR (without mastoidectomy) with a partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP). Audiometric outcomes at 3 months and 1 year postoperatively including bone and air pure tone averages (PTA), air-bone gap (ABG), change in ABG, speech reception threshold (SRT), and word recognition score (WRS). Secondary outcomes included operative time and complication rates of primary and delayed graft failure, tympanic membrane lateralization, prosthesis extrusion, cerebrospinal fluid leak, facial nerve injury, profound hearing loss, persistent tinnitus, and persistent vertigo. Sixty ears underwent primary OCR and were subdivided based on prosthesis type (PORP and TORP) and surgical approach (exoscope vs microscope). Exoscopic OCR was performed on 30 ears (21 PORP, 9 TORP), and microscopic OCR was performed on 30 ears (19 PORP, 11 TORP). In the overall group (PORP + TORP) and in the PORP and TORP subgroups, there were no significant differences in 1) demographics, 2) intraoperative findings, and 3) audiometric outcomes of bone and air PTA, ABG, change in ABG, SRT, and WRS at 1 year postoperatively. Operative time was 64.7 and 59.6 minutes for the exoscopic and microscopic group, respectively (p = 0.4, 95% CI [-16.4, 6.1], Cohen's D = 0.2). Audiometric and surgical outcomes after exoscopic and microscopic OCR are comparable.

Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life.

Background/Objectives: Chronic unilateral vestibular hypofunction (UVH) can lead to disabling vestibular symptoms and a decrease in quality of life. The aim of this study was to investigate etiologies, clinical subtypes, symptoms, and quality of life (QoL) in patients with chronic UVH. Methods: A retrospective study was performed on 251 UVH patients in a tertiary referral center. Inclusion criteria comprised reduced or absent caloric responses, with a caloric asymmetry ratio ≥25%. Patients with central vestibular pathology, symptom duration <3 months, and incomplete responses to questionnaires were excluded. Patient records were assessed for etiologies, secondary vestibular diagnoses, clinical subtypes, and questionnaires related to QoL. Additionally, multiple linear regression analysis was performed to evaluate factors influencing QoL. Results: Thirteen different etiologies were identified, with Menière's Disease as the most prevalent (31%, n = 79). The most frequently reported secondary vestibular diagnoses were benign paroxysmal positional vertigo (BPPV) (21%, n = 54) and persistent postural perceptual dizziness (PPPD) (19%, n = 47). Five distinct clinical subtypes were identified: recurrent vertigo with UVH (47%), rapidly progressive UVH (25%), idiopathic/unknown UVH (18%), slowly progressive UVH (8%), and congenital UVH (2%). Over 80% of UVH patients experienced moderate-to-severe handicap, as indicated by the Dizziness Handicap Inventory. Approximately 20-25% of UVH patients exhibited moderate-to-severe depression and anxiety, based on the Hospital Anxiety and Depression Scale. Multiple linear regression analyses demonstrated that the presence of PPPD significantly reduced QoL in chronic UVH patients. Conclusions: Chronic UVH is a heterogeneous disorder. Secondary vestibular diagnoses like BPPV and PPPD often co-exist and can significantly impact QoL. A structured diagnostic approach and tailored interventions are crucial to address the diverse needs of UVH patients.

Persistent postural perceptual dizziness (PPPD) in pediatric patients after COVID-19 infection

BackgroundPatients with long-COVID suffer from symptoms that continue or develop after a COVID-19 or SARS-CoV-2 infection and are present for four or more weeks after the initial infection. This case series describes a group of previously healthy adolescent patients with long-COVID who were seen in a pediatric vestibular clinic for evaluation of severe dizziness and were diagnosed with persistent postural-perceptual dizziness (PPPD). By presenting their symptoms, management and treatment effects, this study aims to provide a diagnostic and therapeutic framework for providers who encounter these patients. MethodsPatient records were reviewed for past medical history, symptoms, physical exam findings, results of audiometric and vestibular testing, dizziness handicap inventory for patient caregiver (DHI-pc) scores, and treatment recommendations. Parents of patients were contacted for a follow up survey to assess treatment adherence and outcomes including changes in symptoms and return to activity. ResultsA series of 9 adolescent patients were referred from a multidisciplinary long-COVID clinic and diagnosed with PPPD. Recommended treatment included vestibular physical therapy, selective serotonin reuptake inhibitor medication, and cognitive behavioral therapy. The majority of patients experienced an improvement in their symptoms, and all patients had improved activity levels and DHI-pc scores after treatment. ConclusionTo the best of our knowledge, no previous reports exist discussing PPPD in long-COVID patients. This case series provides insight into symptom evolution and treatment efficacy in this patient population.

Cerebellar abscess secondary to metastatic lung adenocarcinoma: a case report

BackgroundCerebellar abscesses are rare, life-threatening infections often originating from bacterial sources, while metastatic brain lesions from lung adenocarcinoma are relatively common. However, the coexistence of a cerebellar abscess secondary to metastatic lung adenocarcinoma is exceedingly rare and presents unique diagnostic and management challenges.Case PresentationWe report a case of a 35 year-old Pakistani female patient with persistent headaches, nausea, and vertigo, who was found to have a large cerebellar mass with features suggestive of metastatic lung adenocarcinoma. Further investigation revealed a concomitant cerebellar abscess. Surgical excision and broad-spectrum antibiotics were initiated, resulting in a favorable outcome.ConclusionThis case showcases the rarity and complexity of cerebellar abscesses due to metastatic lung adenocarcinoma. Timely intervention, including surgery and targeted therapy, is crucial for successful management. Further research is needed to enhance treatment strategies.

Motion sickness whilst reading as a passenger in the car is highly predictive of vestibular migraine.

Vestibular Migraine (VM) is a prevalent vestibular disorder, affecting up to 2.7% of the general population. Despite the establishment of diagnostic criteria by the Bárány Society and its inclusion in the International Classification of Headache Disorders, the clinical diagnosis of VM remains challenging due to its complex pathophysiology and symptom overlap with other dizziness disorders. Motion sickness is a core feature of migraine and can be interrogated through simple questionnaires. This study aims to identify to what extent motion sensitivity can predict VM compared to other causes of dizziness. We conducted a cross-sectional study involving 113 patients from the vestibular neurology clinics at University College London Hospitals. Participants were categorized into VM, Persistent Postural Perceptual Dizziness (PPPD), combined VM and PPPD, and 'other' dizziness etiologies. Data on motion sickness history and dizziness during car travel were collected through structured interviews and analyzed using logistic regression to assess the predictive value of these symptoms for VM. A substantial portion of patients with VM (91.2%) reported nausea or dizziness when reading as a passenger, a symptom significantly more prevalent than in those with PPPD or other dizziness diagnoses. Logistic regression indicated that VM patients are significantly more likely to experience these symptoms compared to non-VM patients, with an odds ratio suggesting a strong predictive value for this symptom in diagnosing VM. The findings highlight increased motion sensitivity while reading in a moving vehicle as a promising diagnostic tool for VM, offering a practical aid in clinical settings to distinguish VM from other vestibular disorders.

A synovial cyst-induced vertebral artery dissection in bow hunter's stroke: illustrative case.

Bow hunter's stroke (BHS) is a rare condition characterized by occlusion of the vertebral artery (VA) due to a head rotation. BHS typically results from neck hyperrotation, often due to anatomical factors. The authors present a case of BHS in a young male patient exacerbated by os odontoideum (OD), resulting in atlantoaxial dislocation, which ultimately led to VA dissection. A man in his 20s presented with persistent dizziness and nausea and initially received a diagnosis of a brain infarction. However, imaging revealed VA dissection caused by an OD with an associated synovial cyst. Surgical intervention, specifically atlantoaxial posterior fixation, resolved the instability and allowed for natural regression of the synovial cysts, preventing further vascular events. In this case, the OD with atlantoaxial dislocation was identified as the causative factor for BHS. The coexistence of a synovial cyst was a unique finding, likely triggered by chronic irritation caused by the OD. This case emphasizes the importance of thorough cervical spinal evaluation in young patients presenting with posterior circulation stroke. https://thejns.org/doi/10.3171/CASE2487.