Benign paroxysmal positional vertigo following whiplash injury: a myth or a reality?

Objective: The aim of the study was to evaluate the true incidence, diagnosis, and treatment ofbenign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish thistype of posttraumatic vertigo from other types of dizziness complained after trauma.Methods: This was a retrospective study comprising patients referred to our center after whiplashinjury. The patients were evaluated with neurotologic examination including bedside andinstrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients wassubmitted before and after treatment and was evaluated. The BPPV patients were separatelyevaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathicBPPV was done.Results: Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, theposterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases.The instrumental neurotologic assessment did not show any alteration of either vestibulospinalreflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioningmaneuver. The Dizziness Handicap Inventory score improved in all patients treated withrepositioning maneuvers, but no difference emerged with idiopathic BPPV data.Conclusion: BPPV after whiplash injury could be unveiled with a simple bedside examination ofperipheral vestibular system, and a treatment could be done in the same session. The diagnosis ofposttraumatic BPPV is not different from the idiopathic form, but the treatment may require moremaneuvers to achieve satisfactory results.