Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: Diagnosis and treatment
ABSTRACT To identify patients with benign paroxysmal positional vertigo (BPPV) among patients with severe traumatic brain injury (TBI) and to evaluate the effectiveness of the Particle Repositioning Maneouvre (PRM).
Eighteen months prospective study of 150 consecutive patients with severe TBI referred to an in-patients rehabilitation department.
A structured interview emphasizing the possible presence of vertigo followed by a detailed neuro-otological examination. Patients diagnosed with BPPV were immediately treated with the PRM.
BPPV diagnosis was based on a positive Dix-Hallpike positional test. PRM efficacy was determined by repeating the positional test 1 or 2 weeks after treatment. Twenty out of 150 (13.3%) patients complained about positional vertigo. The diagnosis of BPPV was confirmed in 10 patients. Signs and symptoms were completely relieved in six patients after a single PRM, while the other four patients needed repeated treatment for complete resolution of BPPV.
About half of the patients with severe TBI who complain about positional vertigo suffer from BPPV. These patients can be efficiently treated by physical maneouvres improving the rehabilitation outcome.
- SourceAvailable from: Athanasios (Thanos) Bibas
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- "The nature and severity of the traumas causing trauma-BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousness. To reinforce the etiological relationship between head trauma and BPPV, we may note that the incidence of BPPV in a study of 150 consecutive severe head trauma patients has been reported to be significantly higher than in the general population (6.6%) . Following the reported high incidence rates, secondary BPPV should be suspected in any case of head trauma accompanied with positional vertigo, and a Dix-Hallpike examination should be included in the diagnostic protocol of these patients, in some cases, despite the consequent patient discomfort. "
ABSTRACT: Background. This study is a review of the incidence, clinical characteristics, and management of secondary BPPV. The different subtypes of secondary BPPV are compared to each other, as well as idiopathic BPPV. Furthermore, the study highlights the coexistence of BPPV with other inner ear pathologies. Methods. A comprehensive search for articles including in the abstract information on incidence, clinical characteristics, and management of secondary BPPV was conducted within the PubMed library. Results. Different referral patterns, different diagnostic criteria used for inner ear diseases, and different patient populations have led to greatly variable incidence results. The differences regarding clinical characteristics and treatment outcomes may support the hypothesis that idiopathic BPPV and the various subtypes of secondary BPPV do not share the exact same pathophysiological mechanisms. Conclusions. Secondary BPPV is often under-diagnosed, because dizziness may be atypical and attributed to the primary inner ear pathology. Reversely, a limited number of BPPV patients may not be subjected to a full examination and characterized as idiopathic, while other inner ear diseases are underdiagnosed. A higher suspicion index for the coexistence of BPPV with other inner ear pathologies, may lead to a more integrated diagnosis and consequently to a more efficient treatment of these patients.International Journal of Otolaryngology 08/2011; 2011:709469. DOI:10.1155/2011/709469
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- "Of the three SCC's within each inner ear, the most common canal involved is the posterior SCC due to its anatomical position relative to the utricle  . The most effective clinical intervention for canalithiasis is the canalith repositioning maneuver (CRM), also known as the Epley maneuver, which can be performed specific to the individual SCC and side of involvement      "
ABSTRACT: 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.Case Reports in Medicine 10/2009; 2009:910596. DOI:10.1155/2009/910596