Vestibular paroxysmia is the name given to the syndrome caused by vascular compression of the vestibulocochlear nerve. The main symptoms of vestibular paroxysmia are recurrent, spontaneous, brief attacks of spinning, non-spinning vertigo or positional vertigo that generally last less than one minute, with or without ear symptoms (tinnitus and hypoacusis). Prior to attributing a patient's symptoms to vestibular paroxysmia, however, clinicians must exclude common conditions like benign paroxysmal positional vertigo, Menière's disease, vestibular neuritis and vestibular migraine. This is usually possible with a thorough history and bedside vestibular/ocular motor examination. Herein, we describe a patient with vestibular paroxysmia that mimicked resolved BPPV with a literature review.
Benign Paroxysmal Positional Vertigo ; Carbamazepine ; Ear ; Humans ; Migraine Disorders ; Neuritis ; Vertigo ; Vestibular Diseases ; Vestibulocochlear Nerve

Case history of a 67-year-old man diagnosed with posterior benign paroxysmal positional vertigo (BPPV) with extremely long latencies after holding the Dix-Hallpike position for five minutes. Additional vestibular assessment indicated partial unilateral hypofunction. The patient had a history compatible with classic BPPV. This patient, however, did not have any positional nystagmus after doing standard positional testing. With extremely prolonged Dix-Hallpike testing (five minutes), the patient experienced nausea and vertigo. Concomitantly classic peripheral nystagmus was observed. After a total of seventeen treatments in a reposition chair a total relief of symptoms was obtained. The extremely long latencies observed in this patient were ascribed to otoconial adherence and/or otoconial size. This type of BPPV has not previously been described.
Aged ; Benign Paroxysmal Positional Vertigo ; Humans ; Nausea ; Nystagmus, Physiologic ; Semicircular Canals ; Vertigo ; Vestibular Diseases ; Vestibular Function Tests

OBJECTIVES: The purpose of this study was to examine the clinical manifestations and significance of pseudo-spontaneous nystagmus (PSN) and head-shaking nystagmus (HSN) in horizontal canal benign paroxysmal positional vertigo (HC-BPPV). METHODS: Two hundred fifty-two patients diagnosed as HC-BPPV were reviewed retrospectively. After excluding 55 patients with ipsilateral vestibular diseases, multiple canal BPPV, or those who were lost to follow-up, we analyzed the direction of PSN and HSN in patients with HC-BPPV. We also compared the clinical characteristics and treatment outcome between PSN-positive and PSN-negative groups. RESULTS: Our study included 197 patients composed of 80 patients with geotropic HC-BPPV and 117 patients with apogeotropic HC-BPPV. PSN was observed in 13.7% patients and HSN was observed in 45.2%. The incidence of HSN was higher in apogeotropic HC-BPPV, while the proportion of PSN was not statistically significant between the two subtypes. There was no directional preponderance in geotropic HC-BPPV, while ipsilesional PSN and contralesional HSN showed higher incidence in apogeotropic HC-BPPV. The dizziness handicap inventory score in the PSN-positive group was higher than that in the PSN-negative group (p<0.001), and the duration of symptom onset in the PSN-positive group was shorter than that in the PSN-negative group (p=0.047). However, there was no significant difference in the treatment outcome between the two groups. CONCLUSIONS: The incidence of HSN was higher than that of PSN in patients with apogeotropic HC-BPPV. Patients with HC-BPPV showing PSN demonstrated more severe initial symptoms and visited the hospital in a shorter period of time after the onset of symptoms.
Benign Paroxysmal Positional Vertigo ; Dizziness ; Humans ; Incidence ; Lost to Follow-Up ; Retrospective Studies ; Treatment Outcome ; Vestibular Diseases

Vertigo/dizziness is a common complaint in patients who are seeking a primary health clinic. Vertigo is traditionally attributed to damage of the vestibular system. Many peripheral and central vestibular disorders are usually presented with vertigo. However, patients with benign paroxysmal positional vertigo (BPPV), a leading cause of vertigo, may present with postural lightheadedness, near faint, imbalance rather than true vertigo. On the contrary, patients with orthostatic hypotension may present with true spinning vertigo, not dizziness. Persistent postural perceptual dizziness, a second most common cause of dizziness (after BPPV), is mainly occurred after organic vestibular disorders such as BPPV or vestibular neuritis, and classified as a chronic functional vestibular disorder. This article describes non-vestibular disorders presenting dizziness and/or vertigos, which conditions may be misdiagnosed as structural vestibular disorders.
Benign Paroxysmal Positional Vertigo ; Diagnosis ; Dizziness ; Humans ; Hypotension, Orthostatic ; Orthostatic Intolerance ; Vertigo ; Vestibular Neuronitis ; Vestibulocochlear Nerve Diseases

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness with a high recurrence rate. This study aimed to analyze the recurrence rate and the risk factors for recurrence using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002–2013) data. SUBJECTS AND METHOD: Patients aged 20 years or older who were diagnosed with BPPV in the period of 2002–2012 and had at least 1 year of monitoring period were included in this study. The diagnosis of BPPV was made when the code for BPPV (KCD-6 code H811) was used or when canalith reposition therapy (EDI code MX035) was entered even in cases with different diagnoses. The risk factors of BPPV recurrence were analyzed. RESULTS: Of the total of 21355 patients diagnosed with BPPV, 5876 patients (28%) demonstrated recurrence. Multiple recurrences were common. When using the univariate regression analysis, age, sex, vestibular disease, headache, osteoporosis, and ischemic heart disease were found significant. When the patients were classified into 4 groups according to age and sex, vestibular diseases were found as a common risk factor for recurrence in all groups, while headache, osteoporosis, hypertension, and ischemic heart disease were significant in females. CONCLUSION: The recurrence rate of BPPV in the Korean adult population was approximately 28% and recurrences were more common in patients aged over 65 and in females. Patients with vestibular diseases were at a higher risk of recurrence regardless of age or sex, while headache, osteoporosis, hypertension and ischemic heart disease increased the risk of recurrence in females.
Adult ; Benign Paroxysmal Positional Vertigo* ; Cohort Studies ; Diagnosis ; Dizziness ; Female ; Headache ; Humans ; Hypertension ; Methods ; Myocardial Ischemia ; National Health Programs ; Osteoporosis ; Recurrence* ; Risk Factors* ; Vestibular Diseases

To assess the clinical application of video head impulse test (vHIT) for vestibular function in vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) patients.Thirty-three patients with VN and 43 patients with BPPV were enrolled from Sir Run Run Shaw Hospital and Ningbo Second Hospital from March 15 to September 10, 2015; and 50 healthy controls were also enrolled in the study. vHIT was used to quantitatively test the vestibulo-ocular reflex (VOR) gains of a pair of horizontal semicircular canals. VOR gains two pairs of vertical semicircular canals, and the corresponding asymmetrical value of three VOR gains. The saccades information was also recorded.Compared with the healthy control group and BPPV patients, the affected horizontal and vertical VOR gains were declined and the corresponding asymmetries were increased in VN patients (all<0.01). BPPV group also showed higher vertical VOR gain asymmetries compared with the healthy control group (all<0.01), but no significant difference was observed in VOR gains and horizontal VOR gain asymmetry (all>0.05). The sensibility of vHIT in diagnosis of VN was 87.9%. Among 33 VN patients, 22 were diagnosed with superior vestibular nerve dysfunction, 7 were found with inferior vestibular nerve dysfunction and 3 were with both dysfunction; and 1 case was not distinguished.Video head impulse test can quantitatively evaluate the vestibular dysfunction of VN and can help early diagnosis of VN, which may be widely used in clinic.
Benign Paroxysmal Positional Vertigo ; diagnosis ; Head Impulse Test ; Humans ; Reflex, Vestibulo-Ocular ; physiology ; Saccades ; physiology ; Semicircular Canals ; innervation ; physiopathology ; Sensitivity and Specificity ; Vestibular Diseases ; classification ; diagnosis ; Vestibular Nerve ; pathology ; Vestibular Neuronitis ; classification ; diagnosis

Objective:To describe the audiological, vestibular and radiological profile of patients with migrainous vertigo. Methods: This is a prospective descriptive study of patients who presented with migrainous vertigo in a tertiary care institute over one year.All patients between the ages of twenty to sixty who presented between 2013 and 2014 with migrainous vertigo diagnosed according to Neuhauser’s criteria were included in this study. The diagnostic intervention was audiovestibular tests and magnetic resonance imaging (MRI) of brain with gadolinium. The main outcome measures were types and degree of auditory and vestibular deficits; MRI findings in migrainous vertigo, and whether age at presentation and duration of symptoms affected these findings.Results:Of the 112 patients recruited, the overall female-to male ratio was 1.7: 1. On pure tone audiogram, 18 (16%) patients had sensorineural hearing loss and this was similar in age groups<41 and >40 years. Caloric abnormalities were seen in 64 (61.5%) patients and there was no significant difference in the younger versus older age groups. MRI abnormality was present in 24% and the commonest finding was deep white matter hyperintensities in the brain. In the <41 age group, there were 8/46 with headache < 7 years (17.3%) and 5/9 (55.5%) with headache for >7 years with MRI abnormalities, and this difference was statistically significant (Chi sq 4.14, p=0.041). Conclusions:Both audiological and vestibular abnormalities were seen in migrainous vertigo patients and older age did not appear to be an additional risk factor for the presence of theseabnormalities. Deep white matter hyperintensities were the commonest abnormality found on MRI scans and longer headache duration was associated with higher chances of MRI abnormalities in younger people.
Vestibular Diseases ; Vertigo

Humans ; Vertigo ; Vestibular Diseases

Humans ; Vertigo ; Vestibular Diseases

Benign Paroxysmal Positional Vertigo ; diagnosis ; therapy ; Humans