The influence of cerebral small vessel diseases on the efficacy of repositioning therapy and prognosis of benign paroxysmal positional vertigo

Abstract

Background: Although vascular risk factors have been found to be closely related to the development of benign paroxysmal positional vertigo (BPPV), the relationship between BPPV and cerebral small vessels diseases (CSVDs) has rarely been discussed in literature. This study set out to investigate the efficacy of repositioning therapy and prognosis among BPPV patients with CSVDs. Methods: We enrolled 553 BPPV patients who had undergone brain MRI, and categorized them into two groups based on the presence or absence of CSVDs. After controlling for other confounders using a propensity score matching (PSM) approach, we compared the incidence of recurrence and residual dizziness (RD). Then, we analyzed the recurrence rate and RD incidence in 176 BPPV patients with CSVDs, and assessed potential risk factors. Results: White matter hyperintensity (WMH, 72.2%) and lacunar infarction (LI, 65.9%) were the two CSVDs that were present in the highest proportion among the BPPV patients. The incidence of RD in patients with CSVDs was significantly higher compared to subjects without CSVDs. Patients with RD (n=100, 56.8%) were older, had more severe WMH, and had a higher incidence of brain atrophy; age and higher Fazekas score were independent risk factors. Among the recurrent patients (n=61, 34.7%), the ages were older, the Fazekas score of WMH was higher, and number of LIs was increased; age was the sole independent risk factor. Conclusion: BPPV patients with a combination of CSVD comorbidities, especially elderly patients with WMHs, are more likely to develop RD, which needs to be paid more attention.

Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV

“…In contrast to the current study, Zang et al. 25 showed that residual dizziness was not linked to gender. The disagreement with the present results may be explained by differences in sample sizing and environmental factors.…”

“…However, after menopause, the effects of sex hormones decrease, and gender differences in residual dizziness decrease. 24 In contrast to the current study, Zang et al 25 showed that residual dizziness was not linked to gender. The disagreement with the present results may be explained by differences in sample sizing and environmental factors.…”

Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers

“…Ischemia of the neuroepithelium of the utricular macula or semicircular canals may facilitate their degeneration with consequent detachment of otoliths (17). Indeed, vascular risk factors have been reported to be closely related to the occurrence and prognosis of BPPV (18). Considering that the labyrinthine artery of the inner ear is a tiny terminal artery, small vessel lesions that directly damage the tiny arteries of the inner ear may lead to microcirculation disorders, which could cause damage to the blood vessels of the inner ear and lead to shedding of otoliths (18).…”

“…Indeed, vascular risk factors have been reported to be closely related to the occurrence and prognosis of BPPV (18). Considering that the labyrinthine artery of the inner ear is a tiny terminal artery, small vessel lesions that directly damage the tiny arteries of the inner ear may lead to microcirculation disorders, which could cause damage to the blood vessels of the inner ear and lead to shedding of otoliths (18). Patients with hypertension, obesity, and diabetes may also have reduced capillary density that negatively affects microvascular tissue perfusion (19).…”

“…Autonomic dysfunction is frequently found in patients with chronic persistent dizziness after excluding other causes (94), such as orthostatic hypotension (95), vascular risk factors (18), and brain atrophy (96). In a study of patients with BPPV who had undergone brain magnetic resonance imaging as research subjects, an association was reported between cerebral small vessel diseases (CSVDs) and RD and recurrence of BPPV (18). It is important that BPPV patients who are prone to RD and/or BPPV recurrence are identified and managed appropriately, specifically older patients with white matter hyperintensity.…”