Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects

Annals of Otology Rhinology & Laryngology 121 (10), 682-8 (Oct 2012)

Balatsouras DG, Ganelis P, Aspris A, Economou NC, Moukos A, Koukoutsis G 

OBJECTIVES  We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. 

METHODS  The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group. 

RESULTS Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence. 

CONCLUSIONS The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.

Vertigo and Stroke: A National Database Survey

Otology & Neurotology (Aug 2012)

Huon LK, Wang TC, Fang TY, Chuang LJ, Wang PC 

OBJECTIVE: To investigate the association between vertigo and stroke in Taiwan using the Bureau of National Health Insurance research database. 

METHODS: Information on adult patients with an index vertigo attack in 2006 was retrieved from Bureau of National Health Insurance research database. All patients with specific diagnostic codes for vertigo were included. Occurrence of stroke during a 1-year follow-up period was identified. Risk factors for stroke were examined. Using χ test, t test, and a multilevel logistic regression model, patients with vertigo were categorized into stroke and nonstroke groups for comparative analyses. An age- and sex- matched control cohort was prepared for comparison. 

RESULTS: Patients with vertigo (n = 527,807) (mean age, 55.1 yr) accounted for 3.1% of the general Taiwanese adult population. The prevalence of stroke among vertigo patients of 0.5% (mean age, 67.8 yr) was slightly higher than that of the control group (0.3%; mean age, 72.3 yr; p<0 .0001=".0001" 3.36-4.23="3.36-4.23" 3.77="3.77" 95="95" a="a" age="age" and="and" artery="artery" atrial="atrial" comorbid="comorbid" conditions="conditions" confidence="confidence" coronary="coronary" diabetes="diabetes" disease="disease" dyslipidemia="dyslipidemia" fibrillation="fibrillation" had="had" hemorrhage="hemorrhage" higher="higher" hypertension="hypertension" increased="increased" interval="interval" ischemic="ischemic" mellitus="mellitus" most="most" nbsp="nbsp" nontypical="nontypical" o:p="o:p" odds="odds" of="of" or="or" p="p" patients="patients" predictor="predictor" prevalence="prevalence" ratio="ratio" significant="significant" stroke="stroke" the="the" those="those" types="types" vertigo="vertigo" was="was" were="were" with="with">

CONCLUSION: Patients with vertigo had higher chance to develop stroke than the control group. Some strokes may initially manifest as peripheral vertigo, and some central vertigo may eventually evolve into a stroke. Middle aged male, diabetes, hypertension, dyslipidemia, coronary artery disease, and atrial fibrillation are risk factors for subsequent stroke in vertigo patients.