Paroxysmal Positional Vertigo: The Role of Possible Vascular Factors in Etiology

Giampietro Ricci, Mario Faralli, Giampietro Ricci, Antonio Frenguelli, Chiara Spuri, Fabrizio Lorngari, Egisto Molini
The Mediterranean Journal of Otology   unpublished
OBJECTIVE: The aim of this work is to examine the influence of vascular damage on several clinical aspects of paroxysmal positional vertigo. MATERIALS AND METHODS: A retrospective study was conducted on 536 consecutive patients with paroxysmal positional vertigo. Various factors associated with vascular risk or clear vascular damage were taken into consideration: hypertension, diabetes, hypercholesterolemia, cerebrovas-cular disease, and ischemic heart disease. Patients were divided into group
more » ... (patients with 2 or more vascular factors) and group B (patients without vascular factors or with only 1 vascular factor). The following clinical parameters of paroxysmal positional vertigo were evaluated: recovery time, nystagmus, relapse, and trend of the active phase. The latter involved a form of paroxysmal positional vertigo characterized by immediate negativization of the objective picture with the first rehabilitative maneuver and a return to positivity at the next follow-up visit. We defined the patients in which the clinical behavior was repeated for at least 3 successive sessions as type 1M (maneuver) _ 3S (sessions) paroxysmal positional vertigo. RESULTS: A comparison (group A vs group B) showed a statistically significant increase (P = .001) in the recovery time of vascular patients (group A), who had a mean number of 3.81 (± 2.75) maneuvers to negativize the clinical picture, as opposed to the mean of 2.44 (± 1.72) for group B. The incidence of atypical nystagmus was 13.6% in group A and 5.4% in group B. The rate of type 1M _ 3S paroxysmal positional vertigo was 25.4% in group A and 6.2% in group B. CONCLUSIONS: Because they affect recovery time, the vascular factors discussed here represent negative elements for the prognosis of the disorder. The frequency of atypical oculomotor patterns leads us to consider other pathogenetic mechanisms aside from lithiasis, as well as the possibility of central vestibulo-ocular reflex distress.