Benign Paroxysmal Positional Vertigo in Patients with Mild Traumatic Brain Injury: A Multidisciplinary Study

Abstract

Background: Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. Previous studies have reported diverse and conflicting results regarding the incidence of BPPV after head trauma (t-BPPV). The aims of this study were to determine the incidence of t-BPPV in patients presenting at a hospital emergency department (ED) with mild traumatic brain injury (TBI) and to assess its risk factors.

Methods: A single-center prospective cohort study was conducted. Patients with mild TBI were included at the ED of the teaching hospital. Dix-Hallpike and supine roll-tests were used to diagnose t-BPPV. Data on demographic and clinical characteristics were collected. The t-BPPV patients were contacted by telephone 1 month after the initial diagnosis and treatment. The t-BPPV rates were calculated. Univariable and multivariable logistic regression models were used to assess risk factors for t-BPPV.

Results: Among the 156 patients included (mean age 65 (SD 17) years), 20 had t-BPPV (incidence of 12.8% (95% CI 7.7-17.9)). Female sex (odds ratio (OR) 4.66 (95% CI 1.45-14.97); P =.010) and high energy trauma (OR 3.80 (95% CI 1.11-12.92); P=.033) were statistically significant risk factors for the occurrence of t-BPPV after mild TBI.

Conclusion: The incidence of t-BPPV in a Dutch population that presents at the ED with mild TBI was 12.8%. Female sex and undergoing high-energy trauma were shown to be risk factors for the occurrence of t-BPPV.

Keywords: Benign paroxysmal positional vertigo; dizziness; emergency department; head injury; traumatic brain injury; vertigo.