Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism
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ORIGINAL ARTICLE
Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism Jeong-Yoon Choi 1,2 & Young-Min Park 3 & Seung Hoon Lee 4 & Jieun Choi 5 & Seung Won Hyun 5 & Jung-Mi Song 6 & Hyo-Jung Kim 6 & Hui Jong Oh 7 & Ji-Soo Kim 1,2 Accepted: 29 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract This study aimed to determine the prevalence and mechanism of linear vertigo reported by the patients during the attacks of benign paroxysmal positional vertigo (BPPV). We prospectively evaluated the characteristics (rotational vs. linear) of positional vertigo in 70 patients with posterior and horizontal canal BPPV using a questionnaire allowing multiple choices. In patients with linear vertigo, we further assessed the directionality of linear vertigo. We adopted the velocity-storage model to explain the occurrence and direction of linear vertigo in these patients with BPPV. Patients reported only rotational vertigo in 46 (46/70, 65.7%), only linear vertigo in 10 (14.3%), and both rotational and linear vertigo in 14 (20%). The patients experienced fear from rotational vertigo in 54 (54/70, 77.1%) and from linear vertigo in 20 (20/70, 28.6%). The direction of linear vertigo was concordant with the direction of inertial acceleration predicted by the velocity-storage model. Patients with BPPV may experience linear as well as rotational vertigo during the attacks. This linear vertigo may be ascribed to centrally estimated inertial acceleration. Keywords Dizziness . Vertigo . Nystagmus . Benign paroxysmal positional vertigo . Velocity storage mechanism
Introduction Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo [1, 2]. The positional vertigo and nystagmus occur due to abnormal stimulation or inhibition of
* Ji-Soo Kim [email protected]
the semicircular canal by the otolithic debris dislodged from the utricular macule into the semicircular canals. The characteristics of positional nystagmus have been well recognized in each type of BPPV [3–5], and the positional vertigo has mostly been considered rotational [6, 7]. We, however, have occasionally encountered patients who reported a feeling of falling, sagging, or pushing, rather than spinning, during the attacks of BPPV, which may be termed as linear vertigo. This study first evaluated the nature of positional vertigo experienced by the patients during the attacks of BPPV to determine the prevalence of linear vertigo. We also attempted to propose a mechanism for linear vertigo in BPPV by adopting the velocity-storage (VS) circuit in the brainstem and cerebellum that functions in estimating angular velocity, inertial acceleration, and gravity direction.
1
Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, South Korea
2
Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea
3
Department of Neurology, Korea Un
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