To analyze the clinical characteristics of elderly patients with benign paroxysmal positional vertigo (BPPV), to provide a basis for the accurate diagnosis of elderly BPPV patients. A retrospective case-control study was conducted to evaluate the clinical data of 12,282 patients diagnosed with BPPV who received treatment at the Vertigo Clinical Diagnosis and Treatment Research Center of Beijing Tiantan Hospital, affiliated with Capital Medical University, between January 2020 and June 2024. Patients were categorized into an elderly group (≥65 years old) and a young-to-middle-aged group (<65 years old). Risk factors, clinical manifestations, and the interval from symptom onset to diagnosis were systematically compared and analyzed. The mean age of elderly BPPV patients was 71.2 ± 5.4 years, with a male-to-female ratio of approximately 1:2. The posterior semicircular canal was the most commonly affected site (62.3%) in elderly patients, and the incidence of horizontal semicircular canal canalolithiasis was higher in the elderly group compared to the young-to-middle-aged group (16.2% vs. 13.6%, p < 0.001). The prevalence of arteriosclerosis-related risk factors (including hypertension, diabetes, hyperlipidemia, and coronary heart disease) was significantly higher (p < 0.001). Elderly patients with BPPV were more likely to experience atypical symptom (40.5% vs. 35.5%, p < 0.001), isolated vestibular symptom episodes lasting more than 1 min (23.1% vs. 21.4%, p = 0.039), and symptoms accompanied by tinnitus (21.0% vs. 18.8%, p = 0.004) and hearing loss (12.7% vs. 8.6%, p < 0.001). The proportion of elderly patients whose vertigo was triggered by typical head or body position changes was significantly lower than that in the younger group (35.3% vs. 39.7%, p < 0.001). Additionally, the time from symptom onset to diagnosis was positively correlated with age (r = 0.122, p < 0.001), and a significantly higher proportion of elderly patients experienced a diagnostic delay exceeding 14 days (35.4% vs. 28.4%, p < 0.001). Elderly patients with BPPV are more likely to present with atypical symptoms, fewer episodes of position-induced vertigo, and a longer symptom duration. Delayed diagnosis is more prevalent among elderly patients.

Purpose:The aim of this study was to assess abnormal eye movement signs during different periods, namely, ictal periods and symptom-free intervals, in patients with vestibular migraine.Patients and Methods:We assessed oculomotor signs using videonystagmography in 90 patients with VM (40 during ictal periods and 50 during symptom-free intervals) according to validated diagnostic criteria.Results:Abnormal saccades, smooth pursuit and optokinetic test results; spontaneous nystagmus; and positional nystagmus were all observed in vestibular migraine patients, and there was no significant difference between different periods. Positional nystagmus was the most common in both the ictal and asymptomatic periods (60% and 36%, respectively). Positional nystagmus was induced in a variety of positions during both periods, and the slow-phase velocity ranged from <2 to 10°/s. The duration of positional nystagmus was over 60s in most cases. Overall, central oculomotor dysfunctions occurred in 27.5% of patients during VM attacks and 4% of patients during symptom-free intervals; this difference was statistically significant (p = 0.002).Conclusion:In patients with VM, abnormal oculomotor signs can be found during both vertigo attacks and asymptomatic intervals. Positional nystagmus is the most common of these abnormalities and can be induced in different positions. The amplitude of these patients' positional nystagmus tends to be low, and the duration tends to be long. Observing changes in eye movements by videonystagmography may be helpful in the diagnosis of VM.

Objective:To analyze the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in the oldest old.Method:The clinical data of elderly patients (≥60 years old) with BPPV diagnosed in the Clinical Center for Vertigo and Balance Disturbance of Capital Medical University between January 2019 and October 2021 was collected, including basic information, clinical symptoms in a structured medical history questionnaire and the time interval from the appearance of symptoms to medical consultation. According to the age, patients were divided into elderly group (60-74 years old) and the oldest old group (≥75 years old), and the demographic information, clinical symptoms and consultation time were compared between the two groups.Results:A total of 3 019 patients with BPPV were included in analysis; there were 415 patients in the oldest-old group with the age of (79.54±3.62) years, and 2 604 patients in the elderly group with the age of (65.59±3.88) years. The incidence of vertigo, dizziness or vertigo triggered by position changes of head or body, headache and autonomic symptoms in the eldest-old group were less common than that in the elderly group (all P<0.05). But hearing loss and other types of dizziness (unable to determine the nature of dizziness or vertigo, or without typical symptoms such as dizziness, balance disorders, or instability) were more common in the eldest-old group than those in the elderly group (all P<0.05). Among 3 019 patients, 1 137 had definite time from symptom onset to diagnosis (1 004 in the elderly group and 133 in the oldest-old group), the proportion of patients with the time from the onset to diagnosis>7 days in the oldest-old group was higher than that in the elderly group ( P<0.05). Conclusion:The oldest old patients with BPPV have more atypical symptoms than the younger elderly patients.

Background When dizziness/vertigo patients presented with balance disorder, it will bring severe morbidity. There is currently lack of research to explore risk factor related balance disorder in dizziness patients, especially in those who walk independently. Aim To investigate risk factors related balance disorder in dizziness/vertigo patients who walk independently. Methods Medical data of 1002 dizziness/vertigo patients registered in vertigo/balance disorder registration database were reviewed. The demographic data, medical history, and risk factors for atherosclerosis (AS) were collected. Enrolled dizziness/vertigo patients could walk independently, completed Romberg test, videonystagmography (VNG), and limits of stability (LOS). The subjective imbalance was patient complained of postural symptom when performing Romberg test. Multivariable logistic regression analyzed risk factors related balance disorder. The receiver operating characteristic (ROC) curve evaluated the utility of regression model. Results Five hundred fifty-three dizziness/vertigo patients who walk independently were included in the final analysis. According to LOS, patients were divided into 334 (60%) normal balance and 219 (40%) balance disorder. Compared with normal balance, patients with balance disorder were older ( P = 0.045) and had more risk factors for AS ( P <0.0001). The regression showed that risk factors for AS (OR 1.494, 95% CI 1.198–1.863), subjective imbalance (OR 4.835, 95% CI 3.047–7.673), and abnormality of optokinetic nystagmus (OR 8.308, 95% CI 1.576–43.789) were related to balance disorder. The sensitivity and specificity of model were 71 and 63% ( P <0.0001). The area under the curve (AUC) was 0.721. Conclusions Risk factors for AS, subjective imbalance, and abnormality of optokinetic nystagmus were predictors for balance disorder in patients with dizziness/vertigo who walk independently.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, especially in the elderly. Several studies have revealed a possible seasonality to BPPV. However, whether the seasonality of BPPV also exists in China is unclear. The characteristics of cardio-cerebrovascular risk factors for BPPV in the cold season have not yet been investigated. Objectives: (1) To investigate the seasonality of BPPV; (2) To explore the relationship between cardio-cerebrovascular risk factors and seasonality of BPPV. Methods: A retrospective observational study was performed in Beijing Tiantan Hospital from Jan 2016 to Dec 2018. The study included 1,409 new-onset BPPV patients aged 18-88 years. The demographic data, onset time, and medical history of BPPV were collected. The meteorological data, including temperature, atmospheric pressure, rainfall, and insolation, was obtained from Beijing Meteorological service. The x 2 goodness of fit test was used to evaluate whether BPPV patients' numbers were significantly different among different months of the year. The Spearman correlation was used to detect the correlation between numbers of BPPV patients diagnosed monthly with each climatic parameter. The chi-square test for linear-by-linear association were used to investigate the relationship between cardio-cerebrovascular risk factor and seasonality of BPPV. Results: November to next March is the top 5 months with higher BPPV patient numbers (P < 0.001). The numbers of BPPV diagnosed monthly were conversely correlated with temperature and rainfall (r = -0.736, P = 0.010; r = -0.650, P = 0.022, respectively), positively correlated with atmospheric pressure (r = 0.708, P = 0.010), but no significant correlated with insolation. BPPV in the cold season (including January, February, March, November, and December) had a higher proportion, accounting for 54.2% of all BPPV patients. Among BPPV patients with ≥2, 1, and none cardio-cerebrovascular risk factors, the cold season accounted for 57.0, 56.0, 49.8%, respectively. As the number of cardio-cerebrovascular risk factors increased, the proportion of patients in the cold season of BPPV increased (P = 0.025). Conclusions: BPPV patients are seen more in the months with low temperature, low rainfall, and high atmospheric pressure. Compared with the non-cold season, BPPV patients have more risk factors for cardio-cerebrovascular diseases in the cold season.

目的 分析良性阵发性位置性眩晕(benign paroxysmal positional vertigo,BPPV)发病的季节特点及影响因素.方法 选取2016年1月至2017年12月首都医科大学附属北京天坛医院神经内科前庭功能检查室BPPV数据库登记的诊断为BPPV并进行手法或仪器复位且基础信息完整的患者830例,收集年龄、性别、发病时间及伴发的高血压、高血脂、糖尿病、冠心病、卒中、突发性聋、偏头痛等情况.采用月/年病例数比评价发病季节规律,分析心脑血管病危险因素与BPPV发病季节的相关性.结果 本组患者中男272例,女558例;平均年龄为(54.1±12.6)岁.1～12月的月/年病例数比分别为9.3％、10.4％、11.0％、8.2％、7.5％、6.7％、7.2％、7.8％、6.7％、6.9％、8.0％和10.4％,其中12月至次年3月寒冷季节病例数占全年的41.0％.合并≥2个心脑血管病危险因素、1个危险因素和无危险因素的患者在寒冷季节发病占比分别为46.2％、43.3％和34.5％,其差异有统计学意义(P=0.013);随着危险因素的增多,寒冷季节发病比例增高(P趋势=0.0046).结论 BPPV好发于寒冷季节,具有多个心脑血管病高危因素者在寒冷季节发病危险性增高.

Objective To investigate characteristics and the recurrent risk of the Benign Paroxysmal Positional Vertigo (BPPV) inyoung and elderly patients. Methods A total of 295 patients with BPPV treated in our clinic between January 2010 to October 2014 were enrolled, including 98 patients aging from 18 to 45 years old (young group) and 197 patients more than 60 years old (elder group). The characteristics and recurrent risks of BPPV in young and elder patients were evaluated. Results There were 41 males and 57 females in young group, and 73 males and 124 females in elderpatients, with no significant difference in gender between two groups(P=0.487). There were no significant difference in the frequency of cases with Meniere's disease, sudden hearing loss, migraine, head trauma, and history surgery (P>0.05). But the prevalence of hypertension, hyperlipemia, diabetes, coronary heart disease, arterial plaque and cerebral infraction in elder group was higher than that in young group (P<0.05). The recurrent rate of BPPV one month after repositioning maneuvers was 19.3% in young group and 29.4% in elder group, with no significant difference (P>0.05). Hypertension, diabetesand cerebralinfraction wereindependent risk factors for the recurrence of BPPV. Conclusion The prevalence of hypertension, hyperlipemia, diabetes, coronary heart disease, arterial plaque and cerebral infraction in elder group was higher than in young group. Hypertension, diabetes and cerebral infraction are independent risk factors for the recurrence of BPPV.

Objective To investigate the clinical characteristics and outcome of patients with coexist of benign paroxysmal positional vertigo (BPPV) and Meniere's disease.Methods A total of 343 cases who were diagnosed with BPPV in the Department of Neurology,Beijing Tiantan Hospital of Capital Medical University from July 2009 to December 2011 were enrolled.The medical records of patients were reviewed.All the patients were followed up for 6 years to determine the outcomes.The clinical characteristics and outcome of patients with coexist BPPV and Meniere's disease were evaluated.Results Among the 343 patients,305 cases had idiopathic BPPV,26 cases had BPPV secondary to other diseases,and 12 patients (3.5％) suffered from both BPPV and Meniere's disease.Compared with idiopathic BPPV,patients with coexist BPPV and Meniere's disease were older (t =3.069,P =0.008)and had a higher recurrence rate of BPPV (x2=27.535,P ＜ 0.001),but there were no differences in gender,duration of BPPV (P ＞ 0.05) and involved semicircular canals (x2=0.003,P =0.958) between the two groups.Conclusion Among patients with BPPV,the incidence of Meniere's disease is about 3.5％.BPPV usually occurs in the late stages of Meniere's disease,Patients with both BPPV and Meniere's disease are older and BPPV is more likely to recur in these patients.

Objective To explore the value of problem-based learning (PBL) in the teaching of dizziness diagnostics for further-studying physicians of neurology. <br> Methods Twenty further-studying neurologists at Beijing Tiantan Hospital were randomized into PBL group and traditional lecture-based learning (LBL) group. After the courses, an examination was performed to compare teaching effect between groups. <br> Results The PBL group achieved a signiifcantly (P<0.05) higher score than the LBL group for case analysis and total points. The performance in theoretical knowledge tests was slightly better for the PBL students, but without statistical difference between groups (P>0.05). <br> Conclusion PBL is effective in teaching of dizziness diagnostics for further-studying physicians, which can foster clinical thinking and problem-solving ability of students. A preparatory training in literature retrieval and basic knowledge maybe further improve the quality of PBL teaching practice.

Objective To compare the clinical presentation,intracranial and extracranial artery stenosis,and the short-term outcomes in patients with basilar artery(BA)stenosis with those without BA stenosis, and to investigate the associations between BA stenosis and poor outcomes in the patients with isolated pontine infarction at discharge. Methods In this prospective study,we recruited patients who were hospitalized for isolated pontine infarction within 7 days of symptom onset from October 2007 to August 2008.We compared the differences in risk factors,clinical features,the baseline neurologic impairment and the outcomes at discharge in patients with and without BA stenosis. Results A total of 101 patients with isolated pontine infarction were included in this study. Differences in central facial palsy and dysphagia(P=0.008 and 0.002)were observed among the 2 groups(with and without moderate to severe BA stenosis/occlusion).When the 2 groups were compared,the neurological impairments on admission were more severe in patients with moderate to severe BA stenosis/occlusion than in patients without BA stenosis(P=0.002).Those with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of intracranial and/or extracranial artery than those without BA stenosis(P=0.009).The multivariable logistic-regression analysis showed that the significant outcome differences between patients with and without moderate to severe BA stenosis/occlusion when adjusted for potential confounding factors(OR 2.7,95%CI 1.07-7.02,P=0.04). Conclusions Patients of isolated pontine infarction with moderate to severe BA stenosis/occlusion had higher incidences of concomitant stenosis of other intracranial and/or extracranial artery. Moderate to severe BA stenosis/occlusion was an independent predictor for poor outcomes at discharge after stroke onset in patients with isolated pontine infarction.