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: PubMed Central[Show abstract] [Hide abstract]
ABSTRACT: Inner ear symptoms like hearing loss, dizziness or tinnitus are often developed after head trauma, even in cases without inner ear destruction. This is also known as labyrinthine concussion. The purpose of this study is to determine the clinical manifestations, characteristics of audiometry and prognostic factors of these patients. We reviewed the medical records of the 40 patients that had been diagnosed as labyrinthine concussion from 1996 to 2007. We studied the hearing levels in each frequency and classified them according to type and degree of hearing loss. Rates of hearing improvement were evaluated according to age, sex, hearing loss type, degree and presence of dizziness or tinnitus. To find out any correlation between hearing improvement and these factors, we used χ(2) test or Fisher's exact test. Bilateral hearing loss was observed in 22 patients, and unilateral hearing loss in 18 patients. There were 4 (6.5%) ascending, 34 (54.8%) descending, 24 (38.7%) flat type hearing loss, which indicated hearing loss was greater in high frequencies than low frequencies. Among 62 affected ears, 20 (32.3%) gained improvement, and it was achieved mainly in low frequencies. There were only 2 ears with dizziness in 20 improved ears and among 20 dizziness accompanied ears, also only 2 ears were improved. High frequencies are more vulnerable to trauma than low frequencies. The hearing gain is obtained mainly in low frequencies, and association with dizziness serves poor prognosis.04/2013; 17(1):13-7. DOI:10.7874/kja.2013.17.1.13
[Show abstract] [Hide abstract]
ABSTRACT: To present the clinical characteristics of secondary BPPV after surgical drilling of the temporal bone. Retrospective study. Tertiary referral academic medical center. Ten patients who developed BPPV after surgical procedure of temporal bone drilling were identified from 965 subjects who underwent surgical drilling of the temporal bone at Seoul National University Bundang Hospital. The localization and lateralization of BPPV were based on positional test using video eye movement recording system and videonystagmography. Onset of BPPV after surgery, distributions of involved semicircular canals, response to particle repositioning maneuver and factors that may influence the development of secondary BPPV after surgical drilling of the temporal bone. Onset of positional vertigo was mostly within 3 days except 1 case (sixth postoperative day). Postoperative BPPV was usually in the contralateral ear in 9 cases (90%), which occurred predominantly on the contralateral horizontal canal in 8 patients (80%). Positional vertigo was resolved after repositioning maneuvers in every case. None of them showed aggravation of bone conduction threshold. The incidence of BPPV after surgical drilling of the temporal bone was around 1%, and the horizontal semicircular canal of the contralateral ear was predominantly involved. Head position during surgery (head restriction to contralateral ear down) as well as limitation of head movement due to compressive mastoid bandage after surgery seems to be responsible for such predominance.Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 10/2013; 34(8):1448-1455. DOI:10.1097/MAO.0b013e318299b376 · 1.60 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background: Generally accepted view is that for the diagnosis of BPPV is sufficient positive positioning test. Objective: To determine the importance of accurate diagnosis in appropriate treatment of certain clinical BPPV forms. Methods: A total of 81 examinees with BPPV were isolated. The diagnosis was made by Dix-Hallpike test and confirmed by VNG. The disability due to disease and risk of falling were monitored by filling the DHI and ABC questionnaires at the beginning and at the end of treatment. Results: In most patients posterior semicircular canal was affected. Involvement of the lateral canals was recorded only by VNG testing. After the appropriate repositioning procedures were performed, there was a significant reduction or complete elimination of symptoms in the majority of subjects (76 or 93.82%). The median total DHI sum amounted to 50.5 (± 22.2) at the beginning and 20.4 (± 18.5) at the end of the study, with p <0.00. Conclusion: Although a subjectively positive Dix-Hallpike or a "supine roll" test is sufficient for the diagnosis of BPPV, it is preferably perform a VNG as well in order to precisely determine the exact localization of the otolith, so that an appropriate repositioning procedure can be applied.Medicinski glasnik 08/2014; 11(2). · 0.20 Impact Factor