Benign paroxysmal positional vertigo as the cause of dizziness in patients after severe traumatic brain injury: Diagnosis and treatment

Loewenstein Rehabilitation Hospital, Ra'anana, and Tel-Aviv University, Israel.
Brain Injury (Impact Factor: 1.81). 09/2005; 19(9):693-7. DOI: 10.1080/02699050400013600
Source: PubMed


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.

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    • "It is assumed that travelling waves from intracranial cerebrospinal fluid following head trauma disrupts the sensory epithelium of vestibular end organs. Third, benign paroxysmal positional vertigo after head trauma has been reported frequently.12,13) Forth, dizziness can be developed by endolymphatic duct disruption which eventually leads to endolymphatic hydrops, Meniere's syndrome. "
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    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.
    Full-text · Article · Apr 2013 · Korean Journal of Audiology
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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%) [15]. 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. "
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    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.
    Full-text · Article · Aug 2011 · International Journal of Otolaryngology
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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 [2] [3]. 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 [2] [3] [4] [5] [6] "
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    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.
    Full-text · Article · Oct 2009 · Case Reports in Medicine
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