Questionnaire-based diagnosis of benign paroxysmal positional vertigo

Neurology ◽  
2019 ◽  
Vol 94 (9) ◽  
pp. e942-e949 ◽  
Author(s):  
Hyo-Jung Kim ◽  
Jeong-Mi Song ◽  
Liqun Zhong ◽  
Xu Yang ◽  
Ji-Soo Kim
Keyword(s):  
Confidence Interval ◽  
Gold Standard ◽  
Benign Paroxysmal Positional Vertigo ◽  
Class Iii ◽  
Positional Vertigo ◽  
National University ◽  
Seoul National University ◽  
Sensitivity Specificity ◽  
Paroxysmal Positional Vertigo

ObjectivesTo develop a simple questionnaire for self-diagnosis of benign paroxysmal positional vertigo (BPPV).MethodsWe developed a questionnaire that consisted of 6 questions, the first 3 to diagnose BPPV and the next 3 to determine the involved canal and type of BPPV. From 2016 to 2017, 578 patients with dizziness completed the questionnaire before the positional tests, a gold standard for diagnosis of BPPV, at the Dizziness Clinic of Seoul National University Bundang Hospital.ResultsOf the 578 patients, 200 were screened to have BPPV and 378 were screened to have dizziness/vertigo due to disorders other than BPPV. Of the 200 patients with a questionnaire-based diagnosis of BPPV, 160 (80%) were confirmed to have BPPV with positional tests. Of the 378 patients with a questionnaire-based diagnosis of non-BPPV, 24 (6.3%) were found to have BPPV with positional tests. Thus, the sensitivity, specificity, and precision of the questionnaires for the diagnosis of BPPV were 87.0%, 89.8%, and 80.0% (121 of 161, 95% confidence interval 74.5%–85.5%). Of the 200 patients with a questionnaire-based diagnosis of BPPV, 30 failed to respond to the questions 4 through 6 to determine the involved canal and type of BPPV. The questionnaire and positional tests showed the same results for the subtype and affected side of BPPV in 121 patients (121 of 170, 71.2%).ConclusionThe accuracy of questionnaire-based diagnosis of BPPV is acceptable.Classification of evidenceThis study provides Class III evidence that, in patients with dizziness, a questionnaire can diagnose BPPV with a sensitivity of 87.0% and a specificity of 89.8%.

Vertigo and Dizziness Related to Migraine: A Diagnostic Challenge

Cephalalgia ◽  
2004 ◽  
Vol 24 (2) ◽  
pp. 83-91 ◽  
Author(s):  
H Neuhauser ◽  
T Lempert
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
International Headache Society ◽  
Familial Hemiplegic Migraine ◽  
Diagnostic Challenge ◽  
Hemiplegic Migraine ◽  
Positional Vertigo ◽  
International Headache Society Classification ◽  
Cerebellar Symptoms ◽  
Paroxysmal Positional Vertigo

Vertigo and dizziness can be related to migraine in various ways: causally, statistically or, quite frequently, just by chance. Migrainous vertigo (MV) is a vestibular syndrome caused by migraine and presents with attacks of spontaneous or positional vertigo lasting seconds to days and migrainous symptoms during the attack. MV is the most common cause of spontaneous recurrent vertigo and is presently not included in the International Headache Society classification of migraine. Benign paroxysmal positional vertigo (BPPV) and Ménière's disease (MD) are statistically related to migraine, but the possible pathogenetic links have not been established. Moreover, migraineurs suffer from motion sickness more often than controls. Persistent cerebellar symptoms may develop in the course of familial hemiplegic migraine. Dizziness may also be due to orthostatic hypotension, anxiety disorders or major depression which all have an increased prevalence in patients with migraine.

Vertigo

2016 ◽  
Author(s):  
Sathiji Nageshwaran ◽  
Heather C Wilson ◽  
Anthony Dickenson ◽  
David Ledingham
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Features ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Circulation ◽  
Treatment Regimes ◽  
Vestibular Paroxysmia ◽  
Positional Vertigo ◽  
Vestibular Neuronitis ◽  
Paroxysmal Positional Vertigo

This chapter on vertigo discusses the classification of vertiginous disorders (peripheral: benign paroxysmal positional vertigo (BPPV), vestibular neuronitis/labyrinthitis, Ménière’s disease, and vestibular paroxysmia; and central: vestibular migraine, posterior circulation stroke, multiple sclerosis, and episodic ataxias), clinical features, treatment regimes, and evidence for treatment.

Vestibular autorotation testing in patients with benign paroxysmal positional vertigo

2000 ◽  
Vol 122 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Peter Belafsky ◽  
Gerard Gianoli ◽  
James Soileau ◽  
David Moore ◽  
Sheri Davidowitz
Keyword(s):  
Gold Standard ◽  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Disorders ◽  
Tertiary Referral ◽  
Perilymphatic Fistula ◽  
Tertiary Referral Center ◽  
Phase Lead ◽  
Vestibular Hypofunction ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

OBJECTIVES: The current gold standard for diagnosis of benign paroxysmal positional vertigo (BPPV) is the Dix-Hallpike maneuver. However, because of fatigability, the Dix-Hallpike is often falsely normal. The objective of this study was to evaluate the utility of vestibular autorotation testing in the diagnosis of BPPV. METHODS: The charts of 210 patients at a tertiary referral center for vertiginous disorders were reviewed. All patients underwent clinical evaluation, Dix-Hallpike testing, audiometry, electronystag-mography, and vestibular autorotation testing. The vestibular autorotation results of patients with BPPV were compared with the findings in patients with non-BPPV vestibular disorders. The sensitivity and specificity of vestibular autorotation testing in diagnosing BPPV were calculated. RESULTS: Ninety-one patients (42.9%) had BPPV, 76 patients (36.2%) had vertigo of uncertain cause, 28 (13.3%) had unilateral vestibular hypofunction, 9 patients (4.3%) had Meniere's disease, and 2 patients (1.0%) had perilymphatic fistula. Patients with BPPV were 3.32 times more likely to have a normal horizontal gain (95% CI = 1.54–7.19). A normal horizontal gain is 85% sensitive but only 36% specific for BPPV. Patients with BPPV were 1.9 times more likely to have vertical phase lead (95% CI = 0.953.93). Patients with BPPV were 2.20 times more likely to have both normal horizontal gain and vertical phase lead (95% CI = 1.03–4.69) The sensitivity of the combination of normal horizontal gain and vertical phase lead on vestibular autorotation testing is 87% specific but only 25% sensitive in the diagnosis of BPPV. CONCLUSION: A normal horizontal gain or vertical phase lead on vestibular autorotation testing in a vertiginous patient is suggestive of but not exclusive to a diagnosis of BPPV. The combination of a normal horizontal gain and vertical phase lead on vestibular autorotation testing is highly suggestive of the diagnosis of BPPV. Adjuvant use of these parameters in vestibular autorotation testing may prove to be helpful in the diagnosis of BPPV.

Clinical Implications of the Center of Balance for a Veteran with Traumatic Brain Injury

2015 ◽  
pp. 280-289
Keyword(s):  
Traumatic Brain Injury ◽  
Case Report ◽  
Brain Injury ◽  
Benign Paroxysmal Positional Vertigo ◽  
Medical Center ◽  
Treatment Plan ◽  
Successful Outcome ◽  
Model Case ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Background: It is known that traumatic brain injury (TBI), even of the mild variety, can cause diffuse multisystem neurological damage. Coordination of sensory input from the visual, vestibular and somatosensory pathways is important to obtain proper balance and stabilization in the visual environment. This coordination of systems is potentially disrupted in TBI leading to visual symptoms and complaints of dizziness and imbalance. The Center of Balance (COB) at the Northport Veterans Affairs Medical Center (VAMC) is an interprofessional clinic specifically designed for patients with such complaints. An evaluation entails examination by an optometrist, audiologist and physical therapist and is concluded with a comprehensive rehabilitative treatment plan. The clinical construct will be described and a case report will be presented to demonstrate this unique model. Case Report: A combat veteran with a history of a gunshot wound to the skull, blunt force head trauma and exposure to multiple explosions presented with complaints of difficulty reading and recent onset dizziness. After thorough evaluation in the COB, the patient was diagnosed with and treated for severe oculomotor dysfunction and benign paroxysmal positional vertigo. Conclusion: Vision therapy was able to provide a successful outcome via improvement of oculomotor efficiency and control. Physical therapy intervention was able to address the benign paroxysmal positional vertigo. The specific evaluation and management as pertains to the aforementioned diagnoses, as well as the importance of an interprofessional rehabilitative approach, will be outlined.

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