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Yu T, Zhang H, Yan YM, Liu YN, Huang XF, Qiao S, Yang Q, Li P, Jiang RC, Ma DC. Correlation of idiopathic benign paroxysmal positional vertigo with cerebral small vessel disease. Am J Emerg Med 2023; 74:140-145. [PMID: 37837822 DOI: 10.1016/j.ajem.2023.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/24/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo, with vascular lesions being one of its suspected causes. The older adults are particularly vulnerable to BPPV. Cerebral small vessel disease (CSVD), on the other hand, is a clinical condition that results from damage of cerebral small vessels. Vascular involvement resulting from age-related risk factors and proinflammatory state may act as the underlying factor linking both BPPV and CSVD. AIM The objective of this study is to explore the potential correlation between BPPV and CSVD by examining whether individuals aged 50 and older with BPPV exhibit a greater burden of CSVD. MATERIALS AND METHODS This retrospective study included patients aged 50 years and older who had been diagnosed with BPPV. A control group consisting of patients diagnosed with idiopathic facial neuritis (IFN) during the same time period was also included. The burden of cerebral white matter hyperintensities (WMHs) was evaluated using the Fazekas scale. An ordinal regression analysis was conducted to investigate the potential correlation between BPPV and WMHs. RESULTS The study included a total of 101 patients diagnosed with BPPV and 116 patients with IFN. Patients with BPPV were found to be significantly more likely (OR = 2.37, 95% CI 1.40-4.03, p = 0.001) to have a higher Fazekas score compared to the control group. Brain infarctions, hypertension, and age were all identified as significant predictors of white matter hyperplasia on MRI, with OR of 9.9 (95% CI 4.21-24.84, P<0.001), 2.86 (95% CI 1.67-5.0, P<0.001), and 1.18 (95% CI 1.13-1.22, P<0.001) respectively. CONCLUSION Our findings suggest that vascular impairment caused by age-related risk factors and proinflammatory status may be contributing factors to the development of BPPV in individuals aged 50 and above, as we observed a correlation between the suffering of BPPV and the severity of WMHs.
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Affiliation(s)
- Ting Yu
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China; Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Hui Zhang
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China; Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Yong-Mei Yan
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China; Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Yan-Ni Liu
- Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Xiao-Feng Huang
- Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Sen Qiao
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China; Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Qi Yang
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Peng Li
- Department of Radiology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China
| | - Ruo-Chen Jiang
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China
| | - Dai-Chao Ma
- The First School of Clinical Medicine, Shaanxi University of Chinese Medicine, China; Department of Neurology, Affiliated Hospital of Shaanxi University of Chinese Medicine, China.
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Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
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Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Korres G, Kitsos DK, Kaski D, Tsogka A, Giannopoulos S, Giannopapas V, Sideris G, Tyrellis G, Voumvourakis K. The Prevalence of Dizziness and Vertigo in COVID-19 Patients: A Systematic Review. Brain Sci 2022; 12:brainsci12070948. [PMID: 35884754 PMCID: PMC9313303 DOI: 10.3390/brainsci12070948] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 12/15/2022] Open
Abstract
Clinical manifestations of COVID-19 include symptoms of vertigo and dizziness, which is rather unsurprising, since SARS-CoV-2 neurotropism may inflict a broad spectrum of neuropathic effects. The widespread nature of central and peripheral audiovestibular pathways suggests that there may be several probable pathophysiological mechanisms. The cytokine storm, CNS infiltration of the virus through ACE 2 receptors, and other systemic factors can be responsible for the significant number of COVID-19 patients reported to experience symptoms of vertigo and dizziness. In this paper, we present a systematic review of clinical studies reporting the detection of dizziness and vertigo as clinical manifestations of COVID-19 and discuss their etiopathogenesis.
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Affiliation(s)
- George Korres
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
- Correspondence:
| | - Dimitrios K. Kitsos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Diego Kaski
- Centre for Vestibular and Behavioural Neuroscience, Department of Clinical and Movement Neurosciences, University College London, 33 Queen Square, London WC1N 3BG, UK;
| | - Anthi Tsogka
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
| | - Vasileios Giannopapas
- 2nd Department of Neurology, Laboratory of Neuromuscular & Cardiovascular Study of Motion (LANECASM), Attikon University Hospital, 124 62 Athens, Greece;
| | - Giorgos Sideris
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Giorgos Tyrellis
- 2nd ENT Department, Attikon University Hospital, 124 62 Athens, Greece; (G.S.); (G.T.)
| | - Konstantine Voumvourakis
- 2nd Department of Neurology, Attikon University Hospital, 124 62 Athens, Greece; (D.K.K.); (A.T.); (S.G.); (K.V.)
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Post-COVID-19 Benign Paroxysmal Positional Vertigo. Case Rep Med 2021; 2021:9967555. [PMID: 34158815 PMCID: PMC8187065 DOI: 10.1155/2021/9967555] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
Background COVID-19 is a disease caused by a new strain of coronavirus (SARS-COVID-19). The WHO first learned about this new virus on December 31, 2019, following a report on a group of cases of “viral pneumonia” in Wuhan, People's Republic of China, and declared a pandemic in March 2020. The disease was an almost complete unknown at the outset, but knowledge of its pathophysiology, clinical picture, and treatment options grew and developed rapidly. Objective Dizziness is a very common symptom that patients report in routine clinical practice and one of the significant clinical manifestations of COVID-19. This short report investigated a possible connection between COVID-19 and benign paroxysmal positional vertigo (BPPV). Methods We present two cases of benign paroxysmal positional vertigo (BPPV), which developed within two weeks of SARS-COVID-19 infection, manifesting with mild disease severity in early November 2020. Results In both cases, the disease manifested by severe, short-lived attacks of vertigo, objective-circular type, with accompanying nausea and vomiting. The symptoms occurred when lying in bed and turning to the right and assuming an upright position. The diagnosis of posterior semicircular canal BPPV (PC-BPPV) was made based on a subjectively and objectively positive right-sided Dix–Hallpike test. Conclusions The pathophysiology of post-COVID BPPV is probably similar to that of other viral infections, with some of its specificities such as inducing hypercoagulation and microthrombus formation, which can cause significant circulatory disorders possibly affecting its pathogenesis.
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Pawlak-Osiñska K, Linkowska K, Grzybowski T. Genes important for otoneurological diagnostic purposes - current status and future prospects. ACTA ACUST UNITED AC 2018; 38:242-250. [PMID: 29984802 DOI: 10.14639/0392-100x-1692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY This review focuses on the current knowledge of the genes responsible for non-syndromic hearing loss that can be useful for otoneurological diagnostic purposes. From among a large number of genes that have been associated with non-syndromic hearing impairment, we selected several best-known genes, including the COCH gene, GJB2, GJB6 and SLC26A4, and we describe their role and effects of mutations and prevalence of mutations in various populations. Next, we focus on genes associated with tinnitus. Important areas for further research include assessment of genes potentially involved in pathophysiology of tinnitus and vertigo, which have traditionally been considered as being of otological aetiology, while advances in neuroimaging techniques have increasingly shifted studies toward neurological correlations.
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Affiliation(s)
- K Pawlak-Osiñska
- Department of Otolaryngology and Oncology Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, Skłodowskiej-Curie 9, Bydgoszcz, Poland
| | - K Linkowska
- Department of Forensic Medicine Division of Molecular and Forensic Genetics Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, Skłodowskiej-Curie 9, Bydgoszcz, Poland
| | - T Grzybowski
- Department of Forensic Medicine Division of Molecular and Forensic Genetics Collegium Medicum in Bydgoszcz Nicolaus Copernicus University, Skłodowskiej-Curie 9, Bydgoszcz, Poland
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Wei W, Sayyid ZN, Ma X, Wang T, Dong Y. Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:178. [PMID: 29619005 PMCID: PMC5871662 DOI: 10.3389/fneur.2018.00178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV). Methods This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student’s t-test, χ2 test, and logistic regression analysis were used as appropriate. A p value less than 0.05 was considered statistically significant. Results The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; p = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, p = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; p = 0.001) and female gender (Relative-risk ratio: 4.563; p = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, p = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver. Conclusion Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
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Affiliation(s)
- Wei Wei
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zahra N Sayyid
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xiulan Ma
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tian Wang
- Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yaodong Dong
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
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