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Force dependency of benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective study
  1. Heiko M Rust1,
  2. Rebecca M Smith2,
  3. Mohammad Mahmud2,
  4. John F Golding3,
  5. Barry M Seemungal2
  1. 1 Neurology, Universitatsspital Basel, Basel, Switzerland
  2. 2 Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College, London, UK
  3. 3 Psychology, University of Westminster, London, UK
  1. Correspondence to Dr Barry M Seemungal, Imperial College London, London, UK; bmseem{at}

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In under 40 year olds, traumatic brain injury (TBI) is the most common cause of disability, with vestibular features of dizziness and imbalance found in c. 80% of acute patients,1 and if persistent, affects employment prospects.2 We recently described a new condition called vestibular agnosia (VA), in TBI with both imbalance and loss of vertigo perception from disrupted cortical connectivity .3 VA increases the risk of non-diagnosis of benign paroxysmal positional vertigo (BPPV) sevenfold .3 Hence, we prospectively assessed the frequency and risk factors for BPPV in TBI to identify cases most at risk of BPPV, since patient with acute TBI vertigo reports are unreliable. We assessed: (1) prevalence of BPPV in acute TBI in a West London Major Trauma Centre; (2) factors that predict BPPV in this cohort.

Data were acquired from a Medical Research Council (UK) funded, 3-year prospective study in acute TBI (August 2017–October 2019) with patients recruited from for St Mary’s Hospital Major Trauma Centre admissions (London, UK). Cases were systematically screened via a once–twice weekly vestibular ward round. The patients who we examined and treated, but deemed not suitable for the prospective mechanistic study, were included in this data set via an additional clinical ethics approval (IRAS ID: 255217).

Inclusion criteria for screening patients:

  • Blunt head injury.

  • Admission to the major trauma ward (or associated wards).

  • Age>18.

Exclusion criteria were:

  • Additional active …

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  • HMR and RMS contributed equally.

  • Contributors All authors contributed equally to this work. HMR and RS designed/conceptualised the study, acquired/analysed the data, drafted the manuscript and composed the table. MM acquired data and revised the manuscript for intellectual content. JFG designed/conceptualized the study, analysed the data and revised the manuscript for intellectual content. BMS designed/conceptualised the study, acquired/analysed the data and drafted the manuscript and supervised the study.

  • Funding This work was supported by the following funders: UK Medical Research Council (MR/P006493/1); National Institute for Health Research, UK (ICA-CDRF-2017-03-070); The Racing Foundation (197/229); Imperial Health Charity (GG1516\100028); U.S. Department of DefenseDefence (CDMRP – FAIN#: W81XWH1810760).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.