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Bow Hunter syndrome (BHS) is a rare disorder characterized by mechanical occlusion of the vertebral artery (VA) during neck rotation, resulting in symptomatic, transient, and positional vertebrobasilar insufficiency. We describe a case of a 76-year-old female who presented with dizziness and right ear tinnitus triggered by right head rotation. Her symptoms would immediately resolve upon returning her head to the neutral position. CT angiogram showed 80% stenosis of the left subclavian artery origin, 50%–70% stenosis of the proximal right internal carotid artery (ICA), and near occlusive stenoses of the origins of the bilateral VAs. After failing conservative management, the patient was treated with left subclavian artery stenting, followed by a right carotid endarterectomy (CEA) 6 weeks later. Follow-up at 1 month showed resolution of paroxysmal symptoms and no neurological sequelae. To our knowledge, there have not yet been reported cases of patients with concurrent BHS, subclavian artery stenosis, and carotid artery stenosis. We suggest that global revascularization via subclavian artery stenting and CEA may be considered as treatment for patients with BHS complicated by other cerebrovascular disease secondary to stenoses of the ICA and subclavian artery. This approach obviates the need for more complex surgery or endovascular intervention of the VA. [ABSTRACT FROM AUTHOR]

Background: Vestibular dysfunction causing imbalance affects c. 80% of acute hospitalized traumatic brain injury (TBI) cases. Poor balance recovery is linked to worse return-to-work rates and reduced longevity. We previously showed that white matter network disruption, particularly of right inferior longitudinal fasciculus, mediates the overlap between imbalance and impaired vestibular perception of self-motion (i.e., vestibular agnosia) in acute hospitalized TBI. However, there are no prior reports tracking the acute-longitudinal trajectory of objectively measured vestibular function for hospitalized TBI patients. We hypothesized that recovery of vestibular agnosia and imbalance is linked and mediated by overlapping brain networks. Methods: We screened 918 acute major trauma in-patients, assessed 146, recruited 39 acutely, and retested 34 at 6 months. Inclusion criteria were 18–65-year-old adults hospitalized for TBI with laboratory-confirmed preserved peripheral vestibular function. Benign paroxysmal positional vertigo and migraine were treated prior to testing. Vestibular agnosia was quantified by participants' ability to perceive whole-body yaw plane rotations via an automated rotating-chair algorithm. Subjective symptoms of imbalance (via questionnaires) and objective imbalance (via posturography) were also assessed. Results: Acute vestibular agnosia predicted poor balance recovery at 6 months. Recovery of vestibular agnosia and linked imbalance was mediated by bihemispheric fronto-posterior cortical circuits. Recovery of subjective symptoms of imbalance and objective imbalance were not correlated. Conclusion: Vestibular agnosia mediates balance recovery post-TBI. The link between subjective dizziness and brain injury recovery, although important, is unclear. Therapeutic trials of vestibular recovery post-TBI should target enhancing bi-hemispheric connectivity and linked objective clinical measures (e.g., posturography). [ABSTRACT FROM AUTHOR]

The article in the Journal of Neurology discusses a case of atypical presentation of posterior canal benign paroxysmal positional vertigo (BPPV) involving a combination of cupulolithiasis in the long arm and canalithiasis in the short arm. The patient experienced vertigo triggered by specific head movements, and diagnostic maneuvers revealed distinct nystagmus patterns associated with different types of BPPV. The study sheds light on the complexity of BPPV variants and the adaptability of the vestibular system in modulating positional nystagmus intensity. Researchers and neurologists can benefit from the insights provided in this report when encountering challenging cases of BPPV. [Extracted from the article]

Background/Objectives: Accurate head positioning is essential for diagnostics of benign paroxysmal positional vertigo (BPPV). This study aimed to quantify the head angles and angular velocities during traditional manual BPPV diagnostics in patients with positional vertigo. Methods: A prospective, observational cohort study was conducted at a tertiary university hospital outpatient clinic. One trained examiner performed the Supine Roll Test (SRT) and the Dix–Hallpike test (DHT) on 198 adults with positional vertigo. The primary outcomes included head angle variability and accuracy and angular velocity variability. The secondary outcomes examined the relationship between the head angle accuracy and participant-reported limitations. Results: The absolute variability for all head angles ranged from ±8.7° to ±11.0°. The yaw axis head angles during the DHT, particularly on the left side, had the highest relative variability (left DHT: coefficient of variance 0.29). Systematic errors included the yaw axis head angles undershooting the target (90°) by 19.7–23.8° during the SRT and the pitch axis head angles undershooting the target (120°) by 7.8–8.7° during the DHT. The left-sided yaw axis in the DHT was undershot by 11.8°, while the right-sided DHT angle was slightly overshot (2.5°). Right-sided yaw axis angles in the SRT and DHT were more accurate than the left-sided ones (right SRT: 19.9°; left SRT: 23.9°; p < 0.0001) (right DHT: 7.0°; left DHT: 13.2°; p < 0.0001). The regression analysis found no association between the participant-reported limitations and head angle accuracy. Conclusions: This study highlights the substantial variability and inaccuracies in head positioning during traditional manual BPPV diagnostics, supporting the relevance of a guidance system to improve BPPV diagnostics. Level of evidence: III. Trial registration: ClinicalTrials.gov identifier: NCT05846711. [ABSTRACT FROM AUTHOR]

Background: Following successful canalith repositioning procedures (CRPs), some patients with benign paroxysmal positional vertigo (BPPV) may experience residual symptoms. There is currently no consensus on whether these residual symptoms are related to the disease duration. Objective: To examine the impact of BPPV duration on the persistence of residual symptoms following successful CRP. Methods: A total of 102 idiopathic BPPV patients were enrolled and categorized into short-course and long-course groups based on the duration of the disease. The course of disease in the short-course group was less than or equal to 7 days. The long course of disease was longer than 7 days. All patients underwent swivel-chair-assisted CRP and were followed up 7–10 days after successful CRP. The Dizziness Handicap Inventory (DHI) questionnaire was administered to all patients before and after CRP. Results: Before CRP, significant differences were observed between the two groups in total DHI score and its subdomains: Physical (DHI-P), Functional (DHI-F), and Emotional (DHI-E) (p < 0.05), indicating that long disease duration significantly affected all patient aspects. After CRP, significant differences remained in total DHI, DHI-P, DHI-F, and DHI-E scores (p < 0.05), with the long-course group consistently scoring higher. However, no significant differences were found in the changes in DHI scores across dimensions before and after CRP between the two groups. Conclusion: The duration of BPPV did not influence CRP outcomes, but patients with a longer disease course were more likely to experience residual symptoms after successful CRP. [ABSTRACT FROM AUTHOR]

Background: Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of peripheral vertigo that constitutes more than half of all occurrences of vestibular disorders. Objective: The objective of this study was to find out the effectiveness of transcranial direct current stimulation (tDCS) along with vestibular rehabilitation therapy (VRT) on dizziness, anxiety, and various cardiovascular parameters. Methods: The present study will be a parallel-group single-blinded randomized controlled trial with concealed allocation. The participants will be randomized into three groups: Group A (VRT group), Group B (tDCS group), and Group C (tDCS + VRT group). The outcome variables will be the Dizziness Handicap Inventory Scale, Beck Anxiety Inventory Scale, and cardiovascular parameters. The outcome variables will be assessed at the baseline, at week 4, and a follow-up at week 6. Results: The result will be presented in the form of mean, standard deviation, median, and P value. Conclusions: The application of cerebellar tDCS along with Brandt-Daroff exercises can be seen as a potent approach to improve the symptoms of BPPV. [ABSTRACT FROM AUTHOR]

Objective: Benign Paroxysmal Positional Vertigo is a vestibular disorder causing vertigo and imbalance. This systematic review and meta-analysis aims to explore the impact of benign paroxysmal positioning vertigo and repositioning maneuvers on postural control. Data Sources: In September 2024, PubMed, Web of Science, Scopus and reference lists of included studies were systematically searched. Articles comparing measures of postural control between patients and controls, and/or pre- and posttreatment were considered relevant. Methods: Study selection, data extraction and identification of risk of bias were done by two researchers. If possible, meta-analysis was performed with Review Manager version 5.4.1 and standardized mean differences were calculated with a random-effects model. Results: Twenty-one of the 37 included studies were useful for meta-analyses. Meta-analyses revealed that benign paroxysmal positional vertigo negatively affects perception of verticality (p <.001; SMD = 0.73; 95% CI = [0.39;1.08]) and sensory orientation (p <.001; SMD = −1.66; 95% CI = [−2.08, −1.23]). The perception of verticality (p <.001; SMD = 0.99; 95% CI = [0.76;1.21]) and sensory orientation (p <.001; SMD = −0.77; 95% CI = [−1.11, −0.44]) improved after treatment with repositioning maneuvers. Results of systematic review indicate stability in gait was impaired, vertigo but improve after repositioning maneuvers. Limits of stability were impaired in older patients, but did not improved after repositioning maneuvers. Conclusion: Benign paroxysmal positioning vertigo affects several underlying components of postural control. Repositioning maneuvers can significantly improve the related postural control impairments. This may partly explain the increased odds of falling in these patients, and the positive treatment effect of repositioning maneuvers on falls and fear of falling. [ABSTRACT FROM AUTHOR]

Background: Currently, there is a ‌paucity of research‌ comparing the clinical characteristics and repositioning efficacy between ‌posterior canal-benign paroxysmal positional vertigo-canalolithiasis (PC-BPPV-ca)‌ and ‌posterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu)‌. Aims/objectives: To observe the clinical characteristics and compare the efficacy of repositioning maneuvers between PC-BPPV-ca and PC-BPPV-cu patients. Material and methods: Clinical information of patients was collected. The G-Force BPPV diagnostic apparatus was used to simulate dizziness handicap inventory (DHI) positional test, and the therapeutic effects, DHI, and sentiment indicators of baseline, and 1-week and 1-month treatment were compared. Results: A total of 92 patients were collected, with 46 cases in each group, and PC-BPPV-cu patients were with the longer disease course and have worse sleep quality than that of PC-BPPV-ca patients. Moreover, the PC-BPPV-cu patients had a shorter latency of nystagmus and a greater intensity of nystagmus (p <.05); however, PC-BPPV-ca patients experienced higher proportion of reverse nystagmus. In terms of repositioning efficacy, the PC-BPPV-cu group had poorer initial efficacy compared to the PC-BPPV-ca group (p <.05). Conclusions: PC-BPPV-cu patients exhibit more extended disease duration, diminished sleep quality, and pronounced nystagmus. Additionally, they tend to experience less effective initial repositioning treatments and continue to present with more pronounced residual depressive symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To determine the frequency and clinical features of new- and early-onset benign paroxysmal positional vertigo (BPPV) after different otologic surgical operations with and without surgical drilling. Methods: All unilateral otologic operations performed at the otolaryngology clinic of a tertiary university hospital between January 2021 and May 2023 were screened, and 437 adult cases were included in the study. Of these patients, those who were diagnosed with BPPV within the first month postoperatively were examined. Results: The overall incidence of BPPV after otologic operations was 2.28% (10 out of 437 patients). This incidence was 3% (8/266 patients) in cases where a drill was used and 1.16% (2/171 patients) in those where a drill was not used. There was no significant difference between the two groups (p > 0.05). Clinical symptoms related to BPPV appeared on average in 13.3 ± 6.8 (range: 3–25) days following surgery and presented as canalolithiasis. All cases involved the posterior semicircular canal (SCC) on the operated side. In addition, one patient with a cochlear implant had involvement of both the posterior and lateral SCCs. All patients responded well to repositioning maneuvers during follow-up. Conclusion: Otologic surgery, especially operations involving drilling, is a potential risk factor for the development of BPPV. Postoperative BPPV, primarily presenting as canalolithiasis in the posterior SCC on the operated side, can be effectively managed with repositioning maneuvers. Clinicians should be vigilant for BPPV in patients experiencing vertigo/dizziness within four weeks following otologic surgery. [ABSTRACT FROM AUTHOR]

Background and Purpose: Atypical posterior canal (pc) benign paroxysmal positional vertigo (BPPV) may be caused by cupulolithiasis (cu), short arm canalithiasis (ca), or jam. The purpose of this study was to describe the clinical presentation and differential diagnosis of pc-BPPV-cu and short arm canalithiasis. Methods: This retrospective observation study identified persons with atypical pc-BPPV based on history and findings from four positional tests. Patterns of nystagmus suggested canal involved and mechanism of BPPV. Interventions included canalith repositioning procedures (CRP). Results: Fifteen persons, 17 episodes of care, met inclusion criteria, 65% referred following unsuccessful CRPs. Symptoms included persistent, non-positional unsteadiness, "floating" sensation, with half experiencing nausea/vomiting. Downbeat nystagmus with/without torsion in Dix-Hallpike (DH) and Straight Head Hang (SHH) position and no nystagmus upon sitting up, occurred in 76% of persons attributed to pc-BPPV-cu. Upbeat nystagmus with/without torsion and vertigo/retropulsion upon sitting up, occurred in 24% attributed to pc-BPPV-ca short arm. During SHH, canal conversion from pc-BPPV-cu to long arm canalithiasis occurred in 31%. The Half-Hallpike position identified pc-BPPV-cu in 71%. The Inverted Release position identified pc-BPPV-cu adjacent short arm and pc-BPPV-ca short arm. Discussion and Conclusion: Persistent, peripheral nystagmus that is downbeat or downbeat/torsion away from involved ear in provoking positions and no nystagmus sitting up, may be attributed to pc-BPPV-cu, and nystagmus that is upbeat or upbeat/torsion towards involved ear upon sitting up may be attributed to pc-BPPV-ca short arm. Both are effectively treated with canal- and mechanism-specific CRPs. for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: (http://links.lww.com/JNPT/A487). [ABSTRACT FROM AUTHOR]

Direction‐changing nystagmus on positional testing is classically ascribed to a central pathology. We herein report a case of a patient with Benign Paroxysmal Positional Vertigo (BPPV) who demonstrated the unusual phenomenon of spontaneously reversing nystagmus, and discuss the theorised mechanisms with a novel illustration. In left lateral position, our patient's Videonystagmography (VNG) demonstrated an initially fast‐phase geotropic nystagmus (leftward‐beating, SPV 29°/s) which then paused for 8 s, then spontaneously reversed direction into a slow‐phase ageotropic nystagmus (rightward‐beating, SPV 7°/s). The rest of the neurootological examination and audiometry were normal. An MRI Brain scan also revealed no intracranial pathology. In subsequent reviews the vertigo resolved after repositioning manoeuvres for Left Horizontal Canal BPPV. With review of existing literature, this case may have exhibited coexistent left canalolithiasis and cupulolithiasis, resulting in simultaneous ampullopetal then ampullofugal forces in a single head position. Other posited theories include that of Endolymphatic Reflux and short‐term central adaptation of the Vestibulo‐Ocular Reflex. This case highlights a diagnostic challenge the otolaryngologists and neurologists may face with an atypical spontaneously reversing nystagmus in BPPV. However it remains a priority to rule out central pathologies first, and calls for specialists to take care in diagnosing horizontal canal BPPV by observing for a period of latency and spontaneous reversal of nystagmus first, so as to perform the appropriate repositioning manoeuvres. Laryngoscope, 135:373–376, 2025 [ABSTRACT FROM AUTHOR]

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, with frequent recurrence, particularly pronounced among middle-aged and elderly populations, significantly affecting patients' quality of life. This study aimed to identify predictive factors for recurrence in middle-aged and older patients with BPPV and to develop a nomogram prediction model based on these predictors. Methods: This retrospective study included 582 participants aged ≥45 years who were selected from the electronic medical records system of the First Hospital of Changsha between March 2021 and March 2024. Randomly chosen participants (n = 407, 70%) constituted the training group, whereas the remaining participants (n = 175, 30%) formed the validation group. This study used LASSO binomial regression to select the most predictive variables. A predictor-based nomogram was developed to calculate the risk of BPPV recurrence. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves with 1,000 bootstrap resampling validations. Decision curve analysis (DCA) was conducted to assess the clinical usefulness of the nomogram. Results: According to findings from least absolute shrinkage and selection operator (LASSO) binomial regression and logistic regression screening, older age, higher levels of uric acid (UA) and homocysteine (HCY), diabetes, migraine, anxiety, and insomnia were identified as independent factors associated with an increased recurrence risk of BPPV. A nomogram model for predicting recurrence risk was developed based on these predictors. The nomogram achieved an AUC (C-statistic) of 0.8974 (95% CI: 0.8603–0.9345) in the training group and 0.8829 (95% CI: 0.8253–0.9406) in the validation group. Calibration curves, after 1,000 bootstrap resamples, demonstrated good agreement between the predicted and actual probabilities in the development and validation cohorts. DCA indicated that the nomogram had clinical utility. Conclusion: The nomogram model incorporating age, UA, HCY, diabetes, migraine, anxiety status, and insomnia demonstrated a strong predictive capability for estimating the probability of BPPV recurrence in middle-aged and elderly patients. This tool is valuable for identifying individuals at high risk of BPPV recurrence and can aid physicians in making informed treatment decisions aimed at reducing recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings. Objective: To compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities. Methods: This prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities. Results: The MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8–78.1), specificity of 90.9% (95% CI: 83.9–95.6), PPV of 88.0% (95% CI: 83.9–95.6), and NPV of 75.8% (95% CI: 67.5–82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2–85.8, Cohen's kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly). Conclusion: Traditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV. Clinical trial registration: ClinicalTrials.gov identifier: NCT05846711. [ABSTRACT FROM AUTHOR]

Background/Objectives: Benign Paroxysmal Positioning Vertigo (BPPV), diagnosed in 46% of older adults with complaints of dizziness, causes movement-related vertigo. This case-control study compared physical activity, frailty and subjective well-being between older adults with BPPV (oaBPPV) and controls. Methods: Thirty-seven oaBPPV (mean age 73.13 (4.8)) were compared to 22 matched controls (mean age 73.5 (4.5)). Physical activity was measured using the MOX accelerometer and the International Physical Activity Questionnaire. Modified Fried criteria assessed frailty. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed subjective well-being. A post-hoc sub-analysis compared all variables compared between frail oaBPPV, robust oaBPPV and robust controls. Significance level was set at α = 0.05. Results: oaBPPV were significantly less physically active and were more (pre-)frail (p < 0.001) compared to controls. They performed significantly less active bouts (p = 0.002) and more sedentary bouts (p = 0.002), and a significantly different pattern of physical activity during the day. OaBPPV reported significantly less time in transportation activities (p = 0.003), leisure (p < 0.001), walking (p < 0.001) and moderate-intensity activities (p = 0.004) compared to controls. Frail oaBPPV were even less active (p = 0.01) and experienced more fear of falling (p < 0.001) and feelings of depression (p < 0.001) than robust oaBPPV and controls. Conclusions: BPPV can induce a vicious cycle of fear of provoking symptoms, decreased physical activity, well-being and consequently frailty. It is also possible that frail and less physically active older adults have an increased prevalence of BPPV. Post-treatment follow-up should assess BPPV, frailty and physical activity to determine if further rehabilitation is needed. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of benign paroxysmal positional vertigo without dizziness, a treatable falls risk factor in people attending outpatient falls clinics. Methods: Over 6 years, 618 people at risk of falls attending 2 falls clinics were assessed for benign paroxysmal positional vertigo, whether dizzy or non dizzy. Data regarding demographics, canal location of positive tests and comorbidities were collected from medical records. Results: Thirty-nine percent (238) of people with falls risk tested positive for benign paroxysmal positional vertigo; 62 (26%) or 1 in 4 of those testing positive were not dizzy. Thirty-nine of 104 (38%) testing positive for single canal benign paroxysmal positional vertigo and twenty-four of 134 (18%) testing positive for multiple canal benign paroxysmal positional vertigo were not dizzy. Comorbidities were common for all with falls risk but did not differentiate for benign paroxysmal positional vertigo on testing. Conclusions: Benign paroxysmal positional vertigo is common in people attending falls clinics and contributes to falls risk. Dizziness is common in BPPV though 26% or 1 in 4 people testing positive were not dizzy and would be missed without mandatory testing. Testing should also include all semicircular canals as multiple-canal involvement was high. IMPLICATIONS FOR REHABILITATION: Benign paroxysmal positional vertigo is a common and treatable falls risk factor, however screening for benign paroxysmal positional vertigo in people who fall usually only occurs if they are dizzy. 1 in 4 people with falls risk who have benign paroxysmal positional vertigo do not report symptoms of dizziness Screening for benign paroxysmal positional vertigo in all people who fall whether dizzy or not, is required to comprehensively identify and treat benign paroxysmal positional vertigo All semicircular canals should be screened for benign paroxysmal positional vertigo as the incidence of multiple-canal involvement is high [ABSTRACT FROM AUTHOR]

BACKGROUND: Vertigo is closely related to clinical neurological disorders. When neurons are damaged or dead, it may lead to abnormalities in the vestibular system and trigger vertigo symptoms. Therefore, it is necessary to explore and analyze the hotspots related to vertigo that are common in clinical neurology. OBJECTIVE: To analyze the vertigo-related histopathological changes in clinical neurology and the research hotspots worldwide using bibliometric methods. METHODS: The WanFang database and Web of Science core set database were searched by the first author to retrieve the research-related literature published from 2014-2023 on the treatment of common vertigo in clinical neurology. A bibliometric analysis of the number of publications, country/region, institution, keywords, co-cited literature, and highly cited literature was peformed using VOSviewer_1.6.19 software to summarize the research hotspots in this research field. RESULTS AND CONCLUSION: Web of Science core set database had the highest number of 174 publications in this field in 2022, and WanFang database had the highest number of 133 publications in this field in 2020. The top 3 countries with the highest number of publications are the United States, Germany, and China. The University of Munich, Germany is the international institution with the highest number of publications in this field, while Chengdu University of Traditional Chinese Medicine is the Chinese institution with the highest number of publications in this field. The results of keyword analysis showed that the research hotspot diseases in this field in China are mainly Meniere’s disease, cervical vertigo, senile vertigo, benign paroxysmal positional vertigo, isolated vertigo, and hypertensive vertigo, and the treatments include acupuncture, rehabilitation, medication (gastrodin, Banxia Baizhu Tianma Tang), and manipulative reduction. International research hotspot diseases in this field mainly include benign paroxysmal positional vertigo, vestibular disorders in new coronavirus cases, Meniere’s disease, vestibular schwannoma, acoustic neuromas, and vestibular migraines, etc., and the hotspot treatments are antivertiginous medications, antidepressant and anxiolytic treatments, and microsurgery. The results of literature co-citation analysis showed that for acute vestibular syndrome with persistent vertigo as the main symptom, three-step bedside ophthalmoscopy (HINTS: Head-Impact-Nystagmus-Strabismus Test) is more sensitive than early MRI in the diagnosis of combined strokes in patients with acute vestibular syndrome, which is the most peer-recognized method of detecting strokes in vestibular syndrome, whereas hormonal therapy is more effective to treat vestibular neuritis patients with paroxysmal vertigo as the main symptom. The results of highly cited literature analysis showed that, in the hot literature included in WanFang database in the past 10 years, acupuncture at Fengchi point and the acupuncture method of inducing resuscitation to improve posterior circulation ischemic vertigo have achieved certain results. The literature published in the past 3 years has indicated that Ginkgo biloba leaf extract+gastrodin, acupuncture+Banxia Baizhu Tang, betahistine+gastrodin, vestibular rehabilitation training+Epley Maneuver, all can improve the vertigo symptoms to different degrees. While there were no featured anti-vertigo drugs indicated in the literature in the Web of Science core set data in the recent 10 years, and most of them are based on traditional anti-vertigo drugs and microsurgery. However, there are a few case reports in the international literature in the last 3 years that found that COVID-19 infection may lead to vestibular neuritis and vertigo symptoms. The onset and progression of vertigo may be closely related to neuronal damage and regeneration. For example, viral infections, inflammatory stimuli, or other pathologic factors may lead to neuronal damage or death, thereby affecting the function of the vestibular system. Vertigo-related diagnosis and treatment standardization guidelines have been published both domestically and internationally. Currently, international guidelines recommend the combination of vestibular rehabilitation and physical rehabilitation for the treatment of vertigo, and Chinese guidelines recommend the combination of Chinese and Western medicine, reduction and acupuncture. However, the level of evidence is not very high, so a large number of large-sample, multicenter randomized controlled trials on anti-vertigo treatment are needed in the future. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionsThe purpose of this study was to explore the experiences of patients and healthcare professionals participating in a randomized feasibility trial exploring the management of acute post-traumatic benign paroxysmal positional vertigo (BPPV), and to establish the acceptability and tolerability of BPPV assessment and treatment procedures.This was a multi-center qualitative study nested within a wider randomized feasibility trial. Purposive sampling was used to gather a cohort of healthcare professionals and patients from three major trauma centres in London, UK. Data were gathered using semi-structured interviews and were analyzed using Framework analysis.Fifteen healthcare professionals and 26 patients participated. Patients and healthcare professionals reported acute BPPV diagnosis was acceptable and practicable. However, divergence was noted regarding views of randomization. Participants proposed several research delivery and protocol modifications for a future trial, including changes to study design and outcome measures.Healthcare professionals and patients participating in a multi-center qualitative study felt post-traumatic BPPV was feasible and acceptable to diagnose and treat acutely. Findings from this study will enhance the content and delivery of a future trial and may assist in influencing the development of clinical practice guidelines. [ABSTRACT FROM AUTHOR]

Objective: To explore alterations in functional connectivity (FC) focusing on hippocampal subfields in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). Methods: We conducted resting‐state functional magnetic resonance imaging (fMRI) on 95 BPPV patients, comprising 50 patients with RD and 45 without. Seed‐to‐voxel and seed‐to‐seed analyses were employed to examine changes in FC between the two groups. The hippocampal subfields, including the bilateral dentate gyrus (DG), cornu ammonis (CA), entorhinal cortex (EC), subiculum, and hippocampal amygdalar transition area (HATA) were selected as seeds. Additionally, we assessed the relationship between abnormal FC and clinical symptoms. Results: Seed‐to‐voxel analysis indicated that, compared to non‐RD patients, those with RD exhibited decreased FC between the right DG and right parietal operculum cortex, right HATA and right precuneus, left HATA and left precuneus, left EC and cerebellar vermis 8/−crus 1, and between the left subiculum and left angular gyrus. Conversely, we observed increased FC between the left CA and left lingual gyrus, as well as between the right CA and right fusiform gyrus in RD patients. Furthermore, these variations in FC were significantly correlated with clinical features including the duration of RD and scores on the Hamilton Anxiety Scale and Dizziness Handicap Inventory. Conclusion: BPPV patients with RD exhibited altered FC between hippocampal subfields and brain regions associated with spatial orientation and navigation, vestibular and visual processing, and emotional regulation. These findings offer novel insights into the pathophysiological mechanisms in BPPV patients with RD following successful CRP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to describe the effects of diabetes mellitus (DM) on vestibular and balance system functions in humans. Because Type 2 diabetes (T2D) represents the majority of individuals affected by this condition, this subgroup is the main focus of this tutorial. Method: Evidence of dysfunction is based on epidemiological, anatomical, physiological, neuroimaging, and clinical findings. Preventative measures, therapeutic interventions, and other mitigating factors are also given consideration. Results: Experimental and clinical findings support the notion that T2D damages vestibular and balance systems to the extent that these effects are more prevalent in patients with higher blood glucose levels and longer duration of the disease. Evidence indicates that T2D increases the occurrence and re-occurrence rates of benign paroxysmal positional vertigo, particularly when it occurs in conjunction with hypertension, osteoarthritis, and otologic disorders like Ménière's disease. Type 2 diabetes also impairs vestibular compensation, which is exacerbated by disease duration. Investigational and clinical studies suggest that galvanic stimulation of the vestibular system can be effective in reducing blood glucose levels and improving rehabilitation outcomes. Conclusion: Because DM is a chronic metabolic condition affecting cochlear, vestibular, and balance system functions, lowering blood glucose levels through diet, pharmacological interventions, and exercise can be effective in mitigating dysfunction. [ABSTRACT FROM AUTHOR]

Benign paroxysmal positional vertigo (BPPV) is the most common cause for vertigo. It is diagnosed by the characteristic nystagmus induced by provocative positional tests. During these positional tests the patient experiences spinning vertigo and neurovegetative symptoms such as nausea and vomiting. This can cause severe discomfort to the patient during treatment and in some cases reduced compliance. Minimal stimulation strategy reduced the episodes of induced vertigo, nausea and vomiting thereby making the treatment maneuvers more tolerable. This study aims to evaluate the utility of minimum stimulus strategy for managing BPPV in a resource limited center. The present study also evaluated the utility of 3rd step vertigo as an alternative marker for recovery nystagmus in predicting the efficacy of Epley's maneuver in treating posterior canal BPPV. All patients diagnosed with canalolithiasis of posterior semicircular canal (pc-BPPV), horizontal semicircular canal (hc-BPPV), anterior semicircular canal (ac-BPPV) and multiple semicircular canal (mc-BPPV) were included in the study. The side on which the maximum symptoms were experienced was asked to the patients and noted. The first positional test done in all patients was the Dix-Hallpike maneuver and minimum stimulation strategy was used for treating BPPV. Appropriate canalolith repositioning maneuvers (CRM) were used to treat BPPV. Positional maneuvers were repeated after the CRM in the same sitting and the treatment was considered successful if nystagmus had disappeared on repeat positional tests. The presence of 3rd step vertigo during Epley's maneuver was documented. A total of 71 patients were enrolled in the study. Patients correctly identified the side of BPPV in 76.31% of cases. 3rd step vertigo was able to predict a successful Epley's maneuver in pc-BPPV with a sensitivity and specificity of 41.67% and 60% respectively. Incidence of 3rd step vertigo was seen in 41.37% of patients with pc-BPPV and in 90.9% of patients with mc-BPPV. Minimal stimulation strategy is useful in reducing the discomfort experienced by the patients with BPPV during treatment and thereby improve the compliance to treatment maneuvers. Patients were able to identify the correct side of BPPV in 76.31% of cases. Third step vertigo could predict successful Epley's reposition maneuver with a sensitivity of 41.67% and specificity of 60% in our cohort. However, more studies with larger sample size are required to ascertain its role as an alternative marker for 'recovery nystagmus'. [ABSTRACT FROM AUTHOR]

The objectives of our study were to assess the effectiveness of the single Epley manoeuvre per session for three consecutive days and to determine the protocol for treating posterior canal-Benign Paroxysmal Positional Vertigo (pc-BPPV). At our tertiary care centre, 410 patients with a confirmed diagnosis of unilateral pc-BPPV were included in a prospective observational study. For all the participants, the Epley manoeuvre was performed once daily for three consecutive days. Patients with persistent vertigo underwent Semont's liberatory manoeuvre and were reassessed after one week. The above protocol was repeated for patients who continued to have symptoms. The majority (40.0%) of patients were seen in the 6th decade, followed by the 5th decade (34.4%). Among the study participants, the mean age was 51.57 ± 9.916 years. The male-to-female ratio is 1:1.05. The right ear was affected by 51.75%, and the left by 48.3%. With this protocol, 392 (95.6%) patients were relieved of symptoms by day 3. A six-month recovery rate of 99.75% was achieved. In our study, 99.8% of patients with unilateral pc-BPPV were cured, and 6.34% had a recurrence of symptoms within six months of follow-up. Hence, combining the Epley and the Semont manoeuvres and repeating the manoeuvres on consecutive days has better improvement. [ABSTRACT FROM AUTHOR]

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by vertigo episodes due to head position changes. Emerging research suggests a link between Vitamin D deficiency and BPPV, attributed to Vitamin D's role in calcium metabolism essential for inner ear function. This study investigates the relationship between Vitamin D levels and the incidence, severity, and recurrence of BPPV. This year-long prospective cohort study was conducted at a tertiary care center, enrolling 100 patients diagnosed with BPPV. Vitamin D levels were measured and classified as deficient, insufficient, or sufficient. Patients identified with Vitamin D deficiency (< 20 ng/mL) received supplementation at a dose of 2000 IU daily for six months. Participants were followed monthly for one year to monitor the incidence and severity of BPPV episodes, assessed using the Vertigo Symptom Scale, and recurrence rates. Statistical analysis included Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models to evaluate the Vitamin D-BPPV relationship. The study revealed that patients with Vitamin D deficiency (< 20 ng/mL) had a 71% incidence of BPPV, compared to 20% in those with sufficient levels. The average severity score was higher in the deficient group (7.5) versus the sufficient group (3.5). Vitamin D supplementation correlated with reduced BPPV incidence and severity over time. The findings indicate a significant link between Vitamin D deficiency and increased BPPV incidence and severity, highlighting Vitamin D's role in vestibular health. These results suggest that Vitamin D supplementation could be integral to BPPV management. Further research, including controlled studies, is needed to understand the mechanisms behind these associations and their clinical implications. [ABSTRACT FROM AUTHOR]

Neurologists encounter a range of neurological disorders triggered by head and neck movement, reflecting an array of underlying pathologies and producing diverse symptoms. This article provides a practically orientated review of 14 disorders and how to diagnose and manage them, including common disorders such as benign paroxysmal positional vertigo and uncommon entities such as arterial compression syndromes leading to stroke or syncope, mobile intraventricular masses and medication withdrawal states. The article considers atypical scenarios including unusual manifestations and important mimics and discusses controversial entities, as well as the risk of misattributing symptoms based on incidental imaging abnormalities. Guidelines are referenced where they exist, while in rarer situations, approaches taken in published cases are described, with the acknowledgement that management decisions are at the clinician's discretion. [ABSTRACT FROM AUTHOR]

Vestibular syncope is a rare condition in which vertigo may cause syncopal attacks; however, the term has been associated with confusion because it has been ascribed to completely different vestibular and neurological conditions, from dizziness to Menière disease (MD), to the neurovegetative symptoms in benign paroxysmal positional vertigo (BPPV) and central vertebrobasilar hyperfusion. A 75‐year‐old woman with vasodepressive vasovagal syncope, confirmed by a tilt test with trinitrine administration, was referred for an audiological and vestibular assessment showing an acute unilateral peripheral vestibular deficit on the right side. The diagnosis is peripheral acute vestibular deficits. Interventions and outcomes are vestibular treatment and rehabilitation. The patient's vasovagal symptoms immediately improved and were completely resolved. Peripheral vestibular deficits might also trigger syncopal episodes and must be considered and studied by a complete audiological and vestibular evaluation. By restoring the peripheral vestibular function of the right labyrinth after vestibular treatment, a complete long‐term resolution of multiple vasovagal syncopal episodes was observed together with normalization of the tilt test. [ABSTRACT FROM AUTHOR]

Background: We present a feasibility study on the development of a 3D-printed (3DP) model of benign paroxysmal positional vertigo (BPPV) and its validation as an educational tool for training in therapeutic maneuvers. Methods: A 1.5:1 3DP model of the human labyrinth, supplemented by a 1:1 3DP model of the skull, was obtained from a computed tomography scan. We presented the model to 15 Emergency Medicine residents, 15 medical students, 15 Otolaryngology residents, and 15 Otolaryngology practitioners from two academic referral centers. Participants performed the Semont and Epley maneuvers on the model twice, once before and once after observing the biomechanics of BPPV using this tool. A specific survey was then administered to assess both performance improvement and satisfaction. Results: All the trainees demonstrated an improving trend on the second attempt. The medical students ameliorated significantly after the training in both Epley (p = 0.007) and Semont maneuvers (p = 0.0134). The Emergency Medicine residents improved significantly in Semont maneuvers (p = 0.0134). Self-reported understanding of the BPPV mechanics improved significantly after training in all the groups (p < 0.05). Conclusions: The preliminary data highlighted the potential benefits of training on the 3DP model for practitioners involved in the first-line management of BPPV. [ABSTRACT FROM AUTHOR]

Introduction Benign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV. Methods Two search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included. Results Epley’s repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley’s manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley’s manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV. Conclusions Brandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy.

Abstract Background Benign paroxysmal positional vertigo is the most common neurootologic disorder, characterized by brief attacks of vertigo aggravated by certain head positions. During the last two decades, several studies were performed in different countries trying to find a relationship between benign paroxysmal positional vertigo and vitamin D3 (25 hydroxyvitamin D) deficiency. Objectives This study aimed to find the relationship between vitamin D3 deficiency and total serum calcium with benign paroxysmal positional vertigo. Patients and methods A case–control study conducted from January 2021 to December 2021, consisted of 62 participants; 30 patients with posterior canal benign paroxysmal positional vertigo and 32 healthy persons considered as a control group. The age and sex of both groups were matched, and diagnosis was made by history and examination (Dix-Hallpike’s maneuver). A blood sample was taken to evaluate serum vitamin D level and total serum calcium. The results were compared between both groups. Results The mean levels of vitamin D3 in patients and control groups were 18.57 ± 9.88 ng/ml and 64.12 ± 24.64 ng/ml, respectively, with a statistically significant difference at p ≤ 0.0001. Moreover, regarding vitamin D3 deficiency below 20 ng/ml between patients and control groups, there was a statistically significant difference p = 0.001. Furthermore, there was no significant difference regarding total serum calcium between the two groups, the mean of both groups was 8.57 ± 0.68 mg/dl and 8.93 ± 0.92 mg/dl for patients and control, respectively, at p = 0.084. Conclusion There might be an association between benign paroxysmal positional vertigo and vitamin D3 deficiency. Moreover, there was no significant difference concerning total serum calcium levels between the patient and control groups.

Key Clinical Message: Repositioning maneuvers for benign paroxysmal positional vertigo (BPPV) designed to induce otoconial movement in one canal can trigger and sometimes unwittingly treat BPPV in other canals. Patients with BPPV are best managed by precisely diagnosing the canal variant and using correctly performed, standardized testing and treatment maneuvers. [ABSTRACT FROM AUTHOR]

Background: Horizontal semicircular canal benign paroxysmal positional vertigo(HSC-BPPV) is the second most common type of BPPV. It is difficult to diagnose and treat, which has a serious impact on the prognosis of patients. Objectives: To study the clinical features of HSC-BPPV and the influencing factors of residual dizziness (RD). Materials and methods: The clinical data of 358 patients with BPPV were retrospectively collected. The differences between HSC-BPPV and posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) were compared, and the influencing factors of RD after HSC-BPPV repositioning were analyzed. Results: ① Compared with PSC-BPPV, HSC-BPPV had a lower success rate of first repositioning (64.7 vs. 75.0%), a higher incidence of RD (57.3 vs. 43.8%), and a higher DHI score (40.0 vs. 34.0), and the differences were statistically significant (p <.05). ② Logistic regression analysis showed that age ≥60 years, secondary, DHI score, successful first repositioning were the influencing factors for the development of RD after HSC-BPPV repositioning (p <.05). Conclusions and significance: The diagnosis and treatment of HSC-BPPV is difficult, and RD is prone to occur. Clinicians need to strengthen the training of HSC-BPPV diagnosis and treatment to reduce the occurrence and progression of RD. [ABSTRACT FROM AUTHOR]

Objectives: The Epley maneuver (EM) shows immediate effect, wherein disappearance of positional nystagmus occurs soon after the EM. Our previous study showed that setting interval times during the EM reduced the immediate effect. The purpose of this study is to identify the head position for which interval time reduces the immediate effect. Methods: Fifty-one patients with posterior canal type of benign paroxysmal positional vertigo (BPPV) were randomly assigned to the following three groups: 10 min interval time set at the first head position of the EM in group A, at the third head position in group B, and at the fourth head position in group C. The primary outcome measure (POＭ) was the ratio of maximum slow-phase eye velocity of positional nystagmus soon after the EM, compared with that measured before the EM. A large ratio value indicates a poor immediate effect of the EM. Results: The POＭ in group A (0.07) was smallest (B: 0.36, C: 0.49) (p < 0.001). Discussion: The interval times at the third and fourth head positions reduced the immediate effect of the EM. Our previous study showed that the effect of BPPV fatigue is continued by maintaining the first head position of the EM. BPPV fatigue constitutes fatigability of positional nystagmus with repeated performance of the Dix-Hallpike test. Our findings may be interpreted in accordance with the theory that the immediate effect of the EM is BPPV fatigue itself, because we observed that the effect of BPPV fatigue is strongest in group A. [ABSTRACT FROM AUTHOR]

Purpose: This study introduces and evaluates the sitting lateral canal maneuver (SLCM), a novel seated repositioning technique for treating geotropic lateral canal benign paroxysmal positional vertigo (BPPV). Methods: We conducted a retrospective chart review at the Hospital of Salerno, focusing on 26 patients diagnosed with geotropic LC-BPPV between 2021 and 2022. The SLCM was applied, and its efficacy was assessed based on the resolution of nystagmus and vertigo symptoms. A 95% confidence interval was calculated to estimate the success rate. Results: The SLCM demonstrated a high success rate, with 22 out of 26 patients (approximately 85%, 22/26 patients) showing positive outcomes. The 95% confidence interval for the success rate ranged from approximately 65.02–100%. These findings suggest that SLCM is a potentially effective intervention for LC-BPPV, especially beneficial for patients who find traditional supine or lateral maneuvers uncomfortable. Conclusion: The SLCM represents a promising alternative to traditional BPPV maneuvers, especially for patients requiring a seated approach. While the initial results are encouraging, further research with larger sample sizes and longer follow-up periods is needed to validate its efficacy and explore its full potential in the management of LC-BPPV. Level of evidence: This study represents a Level IV source of evidence, as defined by the evidence-based practice guidelines. It is a retrospective chart review that involves a moderate cohort of patients diagnosed with geotropic horizontal positional nystagmus consistent with lateral canal benign paroxysmal positional vertigo (LC-BPPV). While the study provides valuable insights into the efficacy of the sitting lateral canal maneuver (SLCM) and contributes to the existing literature on BPPV management, it is important to note the inherent limitations associated with this level of evidence. [ABSTRACT FROM AUTHOR]

Introduction: Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. Methodology: This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. Results: Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. Conclusion: The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility. [ABSTRACT FROM AUTHOR]

Barany Society includes bilateral typical posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) in its classification of multicanal subtype. In the past decade, less-common and atypical subtypes of PSC-BPPV, like short-arm and non-ampullary arm posterior semicircular canalolithiasis, have emerged, requiring the conduct of conventional and auxiliary positional tests on both sides to uncover their bilaterality. Authors hereby report three atypical less-common subtypes of bilateral PSC-BPPV, discussing their clinicodemographic profiles, management by repositioning maneuvers and physical therapy, and follow up. Both Case 2 and Case 3 are precisely tri-canalolithiasis (bilateral ampullary arm posterior semicircular canalolithiasis with co-occurring right non-ampullary arm posterior semicircular canalolithiasis in Case 2 and bilateral short arm with co-occurring left ampullary arm posterior semicircular canalolithiasis in Case 3), which has not been reported previously in the literature. There has been only one previously reported case of bilateral non-ampullary arm semicircular canalolithiasis, and it is now observed in Case 1. [ABSTRACT FROM AUTHOR]