Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism

Choi, Jeong Yoon; Park, Young Min; Lee, Jun Young; Choi, Jieun; Hyun, Sangwon; song, jung mi; Kim, Hyo Jung; Oh, Hui Jong; Kim, Ji Soo

doi:10.1007/s12311-020-01196-6

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…3B). This situation easily occurs in patients with benign paroxysmal positional vertigo, 31 rotational Meniere's attack, 32 or inferior vestibular neuritis. 33 Hence, along with the previous report, our observations of five patients with vestibular syncope during benign paroxysmal positional vertigo attacks may solidify the role of the velocity-storage circuit in generating the vestibulosympathetic reflex.…”

Section: Discussionmentioning

confidence: 99%

Vestibular syncope: clinical characteristics and mechanism

Kwon

Kim

et al. 2022

Ann Clin Transl Neurol

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Background and Objectives: Vestibular syncope is a condition in which vertigo-induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity. Methods: This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54-71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity-storage model into the dual reflex pathways comprising the vestibulo-sympathetic reflex and baroreflex and predicted the cardiovascular responses. Results: Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life-threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular-evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity-storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue. Conclusions: Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.

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Section: Discussionmentioning

confidence: 99%

Vestibular syncope: clinical characteristics and mechanism

Kwon

Kim

et al. 2022

Ann Clin Transl Neurol

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“…We tested our hypothesis by simulating a velocity‐storage model introduced elsewhere 1,13–15 . We postulated that a lesion would impair the connections between the tilt‐coding and translation‐coding cells.…”

Section: Discussionmentioning

confidence: 99%

Periodic vertigo and downbeat nystagmus while supine: Dysfunction of Purkinje cells coding gravity

Lee,

Kim,

Yun

et al. 2023

Ann Clin Transl Neurol

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Cerebellar nodulus and uvula and their connections with the vestibular nuclei form the so‐called velocity‐storage circuit. Lesions involving the velocity‐storage circuit give rise to positional vertigo and nystagmus. Herein, we present a 32‐year‐old man with cerebellar nodulus and uvular hemorrhage who showed periodic vertigo and downbeat nystagmus in the supine position. To explain this unusual pattern, we adopted velocity‐storage model with a lesion on the neural connection between the gravity and inertia estimators, resulting in periodic neural impulses and a gravity bias in a specific position. This report expands the spectrum of central positional nystagmus due to dysfunction of the velocity‐storage mechanism.

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“…Another possible explanation for positional preference is linear vertigo. In patients with BPPV, the discrepancy between the internal representation of gravito-inertial acceleration provided by the otolith and the internal estimation of actual gravity direction increases an erroneous inertial acceleration ( 17 – 19 ). Similarly, we could assume that vestibular imbalance in VN could cause linear vertigo from transient central canal-otolithic perception change.…”

Section: Discussionmentioning

confidence: 99%

The frequency and relationship with vestibular function test results of positional preference in acute vestibular neuritis

Park

Lee²,

Kim³

2022

Front. Neurol.

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ObjectiveTo assess the prevalence and relationship with vestibular function test results of positional preference in acute vestibular neuritis (VN).MethodsWe prospectively recruited 33 patients with VN during the acute phase. We assessed the severity of vertigo with a visual analog scale (VAS) and the degree of spontaneous nystagmus (SN) during sitting, the head rolling to the affected, and the healthy side. Patients performed other vestibular function tests, including ocular and cervical vestibular evoked myogenic potential (VEMP), on the same day or the next day of VNG testing.ResultsTwelve patients (12/33, 36%) with VN complained of more severe vertigo during lying on the affected side compared to the healthy side under visual fixation. Compared to patients without positional preference (without positional preference group), patients with positional preference (with positional preference group) showed a significantly higher VAS and maximal slow phase velocity (SPV) of SN at all positions except lying on the lesion side. However, there was no difference in the SPV gap between the two groups. 30% (10/33) of patients with VN complained of more severe vertigo while lying on the affected side compared to the healthy side without visual fixation. Maximal SPV of SN was not different between the two groups. There was no other significant difference in both canalith and otolith function test results between the two groups regardless of the visual fixation.ConclusionsOne-third of patients with acute VN had more severe vertigo while lying on the affected side than in the supine position. The positional preference was not directly related to the SN intensity or VEMP results. The positional preference might reflect the otolith damage in the setting of activation of the sustained otolith system, not the transient otolithic system.

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Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism

Cited by 11 publications

References 18 publications

Vestibular syncope: clinical characteristics and mechanism

Vestibular syncope: clinical characteristics and mechanism

Periodic vertigo and downbeat nystagmus while supine: Dysfunction of Purkinje cells coding gravity

The frequency and relationship with vestibular function test results of positional preference in acute vestibular neuritis

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