Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo Tends to Reoccur

Atypical Bilateral Posterior Semicircular Canalolithiasis - A Case Series

Barany Society includes bilateral typical posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) in its classification of multicanal subtype. In the past decade, less-common and atypical subtypes of PSC-BPPV, like short-arm and non-ampullary arm posterior semicircular canalolithiasis, have emerged, requiring the conduct of conventional and auxiliary positional tests on both sides to uncover their bilaterality. Authors hereby report three atypical less-common subtypes of bilateral PSC-BPPV, discussing their clinicodemographic profiles, management by repositioning maneuvers and physical therapy, and follow up. Both Case 2 and Case 3 are precisely tri-canalolithiasis (bilateral ampullary arm posterior semicircular canalolithiasis with co-occurring right non-ampullary arm posterior semicircular canalolithiasis in Case 2 and bilateral short arm with co-occurring left ampullary arm posterior semicircular canalolithiasis in Case 3), which has not been reported previously in the literature. There has been only one previously reported case of bilateral non-ampullary arm semicircular canalolithiasis, and it is now observed in Case 1.

Objective findings in patients with multi-canal benign paroxysmal positional vertigo

OBJECTIVE

The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV).

METHODS

We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared.

RESULTS

Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P < .05), mean age (62.47±12.51 vs 59.04±13.72, P < .05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P < .01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups (P < .01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder.

CONCLUSION

Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV.

Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo

OBJECTIVE

To outline the clinical picture of bilateral posterior canal benign paroxysmal positional vertigo.

METHODS

A total of 573 patients with posterior canal benign paroxysmal positional vertigo were classified as having unilateral, or true or pseudo bilateral, posterior canal benign paroxysmal positional vertigo, and were treated with the Epley manoeuvre. Statistical significance was set at p < 0.05.

RESULTS

Of the patients, 483 had unilateral and 90 (15.7 per cent) had bilateral presentation. Of the latter, 72 patients had pseudo bilateral posterior canal benign paroxysmal positional vertigo. Comparisons of site of involvement, male to female ratio and the incidence of associated problems in unilateral, and true and pseudo bilateral posterior canal benign paroxysmal positional vertigo did not reveal any statistically significant differences (p = 0.828, p = 0.200, p = 0.142). Comparisons of the number of manoeuvres required to provide symptom relief and the rate of recurrence were significant (p < 0.05).

CONCLUSION

Identification of true and pseudo bilateral posterior canal benign paroxysmal positional vertigo is important given the differences in aetiology and treatment outcome. Treatment of patients with true bilateral posterior canal benign paroxysmal positional vertigo requires several therapeutic manoeuvre attempts, and patients should be warned about recurrence.

Early management for traumatic benign paroxysmal positional vertigo in traumatically injured patients

OBJECTIVES

The purpose of this study was to identify the clinical features of posttraumatic benign paroxysmal positional vertigo (t-BPPV) in traumatically injured patients, investigating the effectiveness of the early diagnosis and management including canalith repositioning procedures (CRPs).

PATIENTS AND METHODS

The subjects of the present study were 74 patients who were hospitalized in the Trauma Center, Ajou University Hospital. We investigated the relationship between injury mechanisms and t-BPPV. Patients with t-BPPV were categorized into mild (typical BPPV) and severe (bilateral, recurrent, or persistent) types.

RESULTS

Of the 74 patients, 41 were diagnosed with t-BPPV. Nineteen were mild and 22 were severe types. 'A fall' (36%) and 'pedestrian car accident' (32%) were common as the injury mechanisms provoking severe t-BPPV. In the severe t-BPPV group, they were hospitalized longer (as median value, 20 days in the severe group vs. 10 days in the mild group, P = 0.004), stayed longer in intensive care unit (3 days vs. 0 days, P = 0.016), and needed more days until the BPPV management (13.5 days vs. 6 days, P = 0.021). Major trauma (the Injury Severity Score >15) patients had a longer time to implementation of the first CRPs (10 days in major trauma and 3 days in minor trauma patients, P = 0.019).

CONCLUSIONS

Severity of trauma and longer duration of ICU treatment were factors delaying BPPV management. This delay could negatively affect the progress of t-BPPV. Diagnostic and therapeutic maneuvers including CRPs should be performed as early as possible, even in severely injured patients.

A Rare Case of Posttraumatic Bilateral BPPV Presentation

A rare case of a 38-year-old female patient who developed benign paroxysmal positional vertigo (BPPV) three weeks after head trauma is presented. The disease manifested bilaterally, which is not uncommon posttraumatically, but in this case, it manifested itself as canalithiasis of the posterior canal on both sides and cupulolithiasis of the right lateral canal, which to our knowledge is a unique and, until now, unpublished case. The aim of this review is to point out the fact that, in such a complex multicanal and bilateral clinical presentation of BPPV, it is not sufficient to perform only positioning but also additional laboratory tests. With a good knowledge of the etiopathogenesis, pathophysiology and clinical forms of BPPV, we can, in most cases, make an accurate and precise diagnosis of the disease and carry out appropriate treatment.

Clinical signs, MRI findings and outcome in dogs with peripheral vestibular disease: a retrospective study

BACKGROUND

Vestibular dysfunction is relatively common in dogs, with a prevalence of 0.08% reported in primary veterinary care in the UK. There are several studies investigating how to differentiate between peripheral and central vestibular disease but only limited information regarding the possible underlying causes for peripheral vestibular dysfunction in dogs. This study therefore aimed to describe the clinical signs, magnetic resonance imaging findings (MRI), underlying causes and outcome in a large population of dogs diagnosed with peripheral vestibular disease.

RESULTS

One hundred eighty-eight patients were included in the study with a median age of 6.9 years (range 3 months to 14.6 years). Neurological abnormalities included head tilt (n = 185), ataxia (n = 123), facial paralysis (n = 103), nystagmus (n = 97), positional strabismus (n = 93) and Horner syndrome (n = 7). The most prevalent diagnosis was idiopathic vestibular disease (n = 128), followed by otitis media and/or interna (n = 49), hypothyroidism (n = 7), suspected congenital vestibular disease (n = 2), neoplasia (n = 1) and cholesteatoma (n = 1). Long-term follow-up revealed persistence of head tilt (n = 50), facial paresis (n = 41) and ataxia (n = 6) in some cases. Recurrence of clinical signs was observed in 26 dogs. Increasing age was associated with a mild increased chance of diagnosis of idiopathic vestibular syndrome rather than otitis media and/or interna (P = 0.022, OR = 0.866; CI 0.765-0.980). History of previous vestibular episodes (P = 0.017, OR = 3.533; CI 1.251-9.981) was associated with an increased likelihood of resolution of the clinical signs whilst contrast enhancement of cranial nerves VII and/or VIII on MRI (P = 0.018, OR = 0.432; CI 0.251-0.868) was associated with a decreased chance of resolution of the clinical signs.

CONCLUSIONS

Idiopathic vestibular disease is the most common cause of peripheral vestibular dysfunction in dogs and it is associated with advanced age. Incomplete recovery from peripheral vestibular disease is common, especially in dogs presenting with cranial nerve enhancement on MRI but less so if there is previous history of vestibular episodes.