Is posttraumatic benign paroxysmal positional vertigo different from the idiopathic form?

BACKGROUND: Although head trauma is considered a common cause of benign paroxysmal positional vertigo (BPPV), clinical presentation and outcome of traumatic BPPV (t-BPPV) have not been systematically evaluated. OBJECTIVES: To compare the clinical presentation, patient's response to physical treatment, and outcome of patients with t-BPPV with those with the idiopathic form (i-BBPV). SETTING: Tertiary referral neuro-otology outpatient clinic. METHODS: We reviewed the clinical records of 247 consecutive patients with posterior canal BPPV during the years 1997 to 2000. All patients were diagnosed using the Dix-Hallpike test and treated using the particle repositioning maneuver. Patients with an onset of positional vertigo within 3 days of well-documented head trauma were included in the t-BPPV group. The outcome was compared with the outcome of 42 patients with i-BPPV who were similarly treated and followed up. RESULTS: Twenty-one (8.5%) of the 247 patients with BPPV fulfilled the diagnostic criteria for t-BPPV. The most common cause of head trauma was motor vehicle crash, documented in 57% of the cases; half of the patients additionally suffered from a whiplash injury. While the other causes were diverse, common falls were predominant. Only 2 of the patients involved in motor vehicle crashes experienced brief loss of consciousness. Sixty-seven percent of patients with t-BPPV required repeated physical treatments for complete resolution of signs and symptoms in comparison to 14% of patients with i-BPPV (P<.001). During a mean +/-SD follow-up of 21.7 +/- 9.7 months, 57% of t-BPPV patients and 19% of i-BPPV controls had recurrent attacks (P<.004). CONCLUSIONS: The nature and severity of the traumas causing t-BPPV are diverse, ranging from minor head injuries to more severe head and neck trauma with brief loss of consciousness. It appears that t-BPPV is more difficult to treat than i-BPPV, and also has a greater tendency to recur.

[Traumatic benign paroxysmal positional vertigo: diagnosis and treatment].

Although head trauma is the cause of Benign Paroxysmal Positional Vertigo (BPPV) in about 15% of cases, the clinical features and response to treatment in this particular group of patients was not previously evaluated. We present 20 cases of traumatic BPPV: 12 cases identified from 150 consecutive BPPV patients diagnosed in our Dizziness Clinic; and 8 cases diagnosed from 75 consecutive head trauma patients seen in the Emergency Room. In all patients the clinical diagnosis was confirmed by the Dix-Hallpike maneuver and all were treated by the Epley procedure. Treatment results were compared to those of 40 consecutive patients with idiopathic BPPV. There was a wide spectrum and severity of head trauma including road accident (7), different falls (5), blow to the head (5) and miscellaneous (3). Two patients experienced brief loss of consciousness. Only two patients were diagnosed as BPPV before referral to our clinic. When presented to our Dizziness Clinic the patients were diagnosed as follows: unspecified dizziness (7), cervical vertigo (4) and transient ischemic attack (1). Five patients (25%) had bilateral BPPV. Eight patients (40%) had complete resolution of symptoms and signs following a single treatment while 12 patients (60%) required additional physical treatments until complete resolution of BPPV was achieved. During follow-up, 11 patients (55%) had recurrent attacks of BPPV. Thirty-four patients with idiopathic BPPV (85%) had a single successful treatment session while the others required repeated physical treatments until complete resolution of BPPV. We conclude that traumatic BPPV is probably under-recognized or misdiagnosed in clinical practice. Response to a single physical treatment seems to be less favorable than in idiopathic BPPV. The Dix-Hallpike maneuver is mandatory in all patients with dizziness and vertigo following head trauma.