• Clinical science

Persistent postural-perceptual dizziness (Phobic postural vertigo)

Abstract

Persistent postural-perceptual dizziness (PPPD), originally known as phobic postural vertigo (PPV), is an idiopathic disorder that presents with a persistent sensation of non-rotational dizziness or unsteadiness and hypersensitivity to motion, lasting at least 3 months. It is the most common cause of chronic dizziness and it often follows an event that caused acute vertigo or dizziness, such as vestibular neuritis or panic attacks. Typically, patients recover from the initial acute disease, but the feeling of dizziness persists. Treatment consists of vestibular rehabilitation, psychotherapy and, if necessary, SSRIs.

Epidemiology

  • Most common vestibular disorder in people 30–50 years of age

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Idiopathic, but it often follows an event that caused acute vertigo or dizziness; (e.g., vestibular neuritis, Ménière's disease, brain injury, panic attack)

References:[2][1][3]

Clinical features

  • Persistent sensation of non-rotational dizziness or unsteadiness for at least 3 months
    • Symptoms are present ≥ 15 of every 30 days, although most patients experience daily symptoms
    • Dizziness typically worsens with motion of both the patient and his or her surroundings
  • PPPD patients often suffer from anxiety and/or depressive disorders

References:[2][1][3]

Diagnostics

There are no tests for PPPD and physical examination is usually unremarkable.

References:[3]

Differential diagnoses

See differential diagnoses for vertigo

The differential diagnoses listed here are not exhaustive.

Treatment

The following measures are indicated for all patients:

References:[2][3]

Prognosis

The majority of patients recover completely or improve considerably.

References:[2][1][3][4]

  • 1. Holle D, Schulte-Steinberg B, Wurthmann S et al. Persistent postural-perceptual dizziness: a matter of higher, central dysfunction?. PLoS One . 2015; 10(11). doi: 10.1371/journal.pone.0142468.
  • 2. Saraiva R, Bittara M, von Söhsten Lins EMD. Clinical characteristics of patients with persistent postural-perceptual dizziness. Brazilian Journal of Otorhinolaryngology. 2015; 81(3): pp. 276–282. doi: 10.1016/j.bjorl.2014.08.012.
  • 3. Vestibular Disorders Association. Persistent Postural-Perceptual Dizziness. https://vestibular.org/pppd. Accessed May 23, 2017.
  • 4. Pollak L, Klein C, Stryjer R, Kushnir M, Teitler J, Flechter S. Phobic postural vertigo: a new proposed entity. IMAJ. 2003; 5. url: https://www.ima.org.il/filesupload/imaj/0/54/27309.pdf.
last updated 11/19/2018
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