Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination

Abstract

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

Keywords: benign paroxysmal positional vertigo; chronic cerebrospinal venous insufficiency; jugular veins; labyrinth diseases; ultrasonography doppler.

Figure 1

Physiological flow in the internal jugular vein normodirected and phasic with breathing. Peak velocity of 36.6 cm/s.

Figure 2

Pathological flow showing high velocity and turbulence in the internal jugular vein (peak velocities of 219.7 cm/s (A) and 170.6 cm/s) (B).

Figure 3

Hypomobile valvular septum obstructing the lumen of the internal jugular vein at M-mode analysis.