Presence Of Benign Paroxysmal Positional Vertigo Research Articles

Presence of Spontaneous Nystagmus, Benign Paroxysmal Positional Vertigo, and Tumarkin Fall in Patients With Primary Headache and Their Responses to Caloric and Video Head Impulse Tests.

Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients' responses to bithermal caloric irrigation and video head impulse test (vHIT). Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients' responses to bithermal caloric irrigation and vHIT were analyzed. There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups. In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms.

Research Letter: Rate of BPPV in Patients Diagnosed With Concussion.

The purpose of this study was to investigate the incidence of benign paroxysmal positional vertigo (BPPV) specifically among patients with dizziness in the rehabilitation phase of concussion recovery and to provide evidence regarding the importance of BPPV assessment in physical therapy concussion evaluations. Outpatient neurologic rehabilitation center at a suburban comprehensive rehabilitation hospital. Fifty patients diagnosed with concussion and referred to vestibular physical therapy with complaints of dizziness were tested for BPPV within their first 3 visits. In this prospective cohort study, a positive Dix-Hallpike test or Horizontal Roll test indicated the presence of BPPV. The primary outcome measure was the presence of BPPV. Additional demographic and injury-specific variables were also considered. Among secondary outcomes, patient characteristics and Dizziness Handicap Inventory scores were compared on the basis of presence or absence of BPPV. Eleven participants, 22%, tested positive for BPPV. Only fall, as the mechanism of injury, was statistically significant ( P < .05), with 72.7% of those who tested positive for BPPV reporting having been injured in a fall compared with 30.8% in the negative group. Nearly half, 45%, of the participants who were positive for BPPV had resolution of their BPPV within 1 visit. This study is unique in its focus on mild traumatic brain injury in the rehabilitation phase of recovery. The results provide evidence regarding the importance of BPPV assessment in physical therapy concussion evaluations.

Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover

Idiopathic benign paroxysmal positional vertigo (BPPV) is a strong indicator of decreased bone density (osteopenia/osteoporosis) in postmenopausal women, and there is a correlation between BPPV and serum levels of biochemical markers of bone turnover. Prospective pilot clinical trial. Two groups of postmenopausal women were recruited. The BPPV group consisted of 16 women with a diagnosis of BPPV. The OSTEO group consisted of 13 women with history of osteopenia/osteoporosis. Dual-energy x-ray absorptiometry scan results were compared, along with serum levels of ionized calcium (iCa), vitamin D, aminoterminal propeptide of protocollagen type I (P1NP), and aminoterminal telopeptides of collagen (sNTX). Prevalence of decreased bone mass density among BPPV subjects was 81%, and prevalence of BPPV among OSTEO subjects was 31%. BPPV subjects had higher P1NP levels. Multiple regression analysis showed that among BPPV subjects, there was positive correlation between P1NP and sNTX and a negative correlation between P1NP and vitamin D level. Age was positively correlated with serum levels of both biomarkers among the BPPV subjects. T score, serum iCa, and serum vitamin D levels did not appear to correlate with presence of BPPV. Idiopathic BPPV subjects have a high prevalence of osteopenia/osteoporosis. Levels of biochemical markers of bone turnover correlate with presence of BPPV. Our results, based on a sample of U.S. subjects, support an association between idiopathic BPPV and disorders of bone turnover.

Benign Paroxysmal Positional Vertigo Is Not a Prognostic Factor in Sudden Sensorineural Hearing Loss

Little is known concerning the role of benign paroxysmal positional vertigo (BPPV) as a prognostic factor for sudden sensorineural hearing loss (SSNHL). The purpose of this study is to analyze the hearing recovery in patients who have SSNHL with BPPV compared with those who have SSNHL without BPPV. The study also documented the relative incidence of each semicircular canal involvement. Case-control study. Academic tertiary otologic practice. Ninety patients diagnosed with SSNHL with vertigo were enrolled. Clinical characteristics such as gender, age, and pure tone audiogram threshold were compared between group A (SSNHL with BPPV, n = 17) and group B (SSNHL without BPPV, n = 73). The frequency of each canal involvement was compared between group A and another 111 patients with BPPV only (group C). The proportion of patients with hearing recovery was compared between patients with or without BPPV, and between those with or without canal paresis. Patients in group A did not display significant differences in the sex ratio, mean age, or initial results of pure tone audiogram threshold compared with those in group B. Most patients with SSNHL with BPPV had lateral canal canalithiasis (64.7%). The presence of BPPV had no influence on the recovery of hearing. The clinical characteristics of patients with SSNHL with BPPV were not different from those with SSNHL without BPPV. The lateral canal was the most frequently involved, and the presence or absence of BPPV had no dramatic impact on the outcome of SSNHL.

Neuro-otological symptoms in patients with migraine

Introduction Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. Patients and methods A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertig o (MARV), and Meniere's disease. Results A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. Conclusions Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are nonspecific and are seen to be associated with other conditions.

Síntomas neurootológicos en pacientes con migraña

Introduction Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. Patients and methods A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertig o (MARV), and Meniere's disease. Results A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. Conclusions Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions.

Clinical Management of a Patient with Chronic Recurrent Vertigo Following a Mild Traumatic Brain Injury

Vertigo, was provoked and right torsional up-beat nystagmus was observed in a 47-year-old patient when she was placed into the right Hallpike-Dix test position using infrared goggle technology. The clinical diagnosis was benign paroxysmal positional vertigo (BPPV), specifically right posterior canalithiasis, resulting from a mild traumatic brain injury (TBI) suffered approximately six-months earlier. Previous medical consultations did not include vestibular system examination, and Meclizine was prescribed to suppress her chief complaint of vertigo. Ultimately, the patient was successfully managed by performing two canalith repositioning maneuvers during a single clinical session. The patient reported 100% resolution of symptoms upon reexamination the following day, and the Hallpike-Dix test was negative. Continued symptom resolution was subjectively reported 10 days postintervention via telephone consultation. This case report supports previous publications concerning the presence of BPPV following TBI and the need for inclusion of vestibular system examination during medical consultation.