Description of a new type of benign recurrent vertigo of central origin

Recurrent Vestibular Symptoms Not Otherwise Specified: Clinical Characteristics Compared With Vestibular Migraine and Menière's Disease

Despite the huge progress in the definition and classification of vestibular disorders within the last decade, there are still patients whose recurrent vestibular symptoms cannot be attributed to any of the recognized episodic vestibular syndromes, such as Menière's disease (MD), vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV), vestibular paroxysmia, orthostatic vertigo or transient ischemic attack (TIA). The aim of the present international, multi-center, cross-sectional study was to systematically characterize the clinical picture of recurrent vestibular symptoms not otherwise specified (RVS-NOS) and to compare it to MD and VM. Thirty-five patients with RVS-NOS, 150 patients with VM or probable VM and 119 patients with MD were included in the study. The symptoms of RVS-NOS had been present for 5.4 years on average before inclusion, similar to VM and MD in this study, suggesting that RVS-NOS is not a transitory state before converting into another diagnosis. Overall, the profile of RVS-NOS vestibular symptoms was more similar to VM than MD. In particular, the spectrum of vestibular symptom types was larger in VM and RVS-NOS than in MD, both at group comparison and the individual level. However, in contrast to VM, no female preponderance was observed for RVS-NOS. Positional, head-motion and orthostatic vertigo were reported more frequently by patients with RVS-NOS than MD, while external vertigo was more prevalent in the MD group. At group level, the spectrum of attack durations from minutes to 3 days was evenly distributed for VM, while a small peak for short and long attacks in RVS-NOS and a big single peak of hours in MD were discernible. In general, vertigo attacks and associated vegetative symptoms (nausea and vomiting) were milder in RVS-NOS than in the other two disorders. Some patients with RVS-NOS described accompanying auditory symptoms (tinnitus: 2.9%, aural fullness and hearing loss: 5.7% each), migrainous symptoms (photophobia, phonophobia or visual aura in 5.7% each) or non-migrainous headaches (14%), but did not fulfill the diagnostic criteria for MD or VM. Absence of a life time diagnosis of migraine headache and attack duration of <5 min were further reasons not to qualify for VM. In some RVS-NOS patients with accompanying ear symptoms, attack durations of <20 min excluded them from being diagnosed with MD. These findings suggest that RVS-NOS is a stable diagnosis over time whose overall clinical presentation is more similar to VM than to MD. It is more likely to be composed of several disorders including a spectrum of mild or incomplete variants of known vestibular disorders, such as VM and MD, rather than a single disease entity with distinct pathognomonic features.

Clinical features and outcomes of benign recurrent vertigo: A longitudinal study

OBJECTIVE

To study the demographics, vertigo profiles, and outcomes of adult patients with benign recurrent vertigo (BRV).

PATIENTS AND METHODS

This prospective study included patients with BRV who were admitted to a tertiary neurology clinic between June 2013 and June 2017. All patients underwent detailed clinical interviews and related examinations. A follow-up was then conducted through an outpatient or telephone interview.

RESULTS

A total of 66 patients (48 females) were enrolled, and the mean age at the onset of vertigo was 35.2 years. Spontaneous vertigo was the most common type (77.8%), followed by positional vertigo (16.7%). The duration of vertigo attacks varied from minutes to 72 hours. A family history of migraine and/or recurrent vertigo was reported in 51.5% of patients. The overall response rate was 80.3%（53/66）after a median follow-up time of 32.5 months (range: 18-60 months). Forty (75.5%, of 53) patients still reported having vertigo attacks at the follow-up. The frequency of vertigo attacks was reduced in 32 (60.4%) patients and was unchanged in 8 (15.1%). Four (7.5%) cases developed into vestibular migraine, but none developed into Meniere's disease.

CONCLUSION

The outcomes of patients with BRV were benign, and the frequency of vertigo is significantly reduced. Few cases developed into vestibular migraine.