Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

Abstract

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

Prevalence of Pediatric and Adolescent Balance Disorders: Analysis of a Mono-Institutional Series of 472 Patients

“…Children with BPPV made up 10.2% of the total cases of vertigo, with a mean age of 11 ± 3 years: the female to male ratio was 2:1. On the other hand, in our sample children with post-traumatic vertigo were only 1.5% of the total, although in the literature patients with post-concussion syndrome and dizziness reach 29.4% [42]. Similar to adults, BPPV appears during awakening in the morning or at night, which can cause a child to be convinced of having had nightmares.…”

Estimating the causal effect of frailty index on vestibular disorders: A two-sample Mendelian randomization

“…Notably, the prevalence of frailty and prefrailty was 45.9% in the young adults in a previous study (Yasuda, 2021 ). A growing number of young people suffer from benign paroxysmal positional vertigo (BPPV, one of the most primary vestibular disorders), in which frailty is one of the risk factors for BPPV in young people (Wang et al, 2021 ). Therefore, in addition to vestibular degeneration associated with frailty, more mechanisms need to be explored as frailty becomes younger.…”

Vertigo and Dizziness in Children: An Update

“…Patients with a history of head trauma are also recognized to be more prone to develop vestibular disorders, such as BPPV; therefore, it is a key piece of information during medical consultation [32].…”