Persistent Postural-Perceptual Dizziness
Description[edit | edit source]
Persistent Postural-Perceptual Dizziness (PPPD or 3PD) is a chronic disorder presenting with continual subjective dizziness or unsteadiness. Upright positions and environments with complex visual stimuli worsen symptoms and are perceived as a threat. These predominant symptoms may lead to incidental complications such as fear avoidance and functional gait abnormalities.[1]
Incidence and Prevalence[edit | edit source]
The World Health Organization (WHO) included PPPD in the 11th edition of the International Classification of Diseases as a new diagnosis to unify varied and overlapping predecessors such as phobic postural vertigo, space-motion discomfort, visual vertigo, chronic subjective dizziness, psychogenic gait disorders, etc. [1]
As this disorder has recently been redefined, valid data is difficult to obtain. Prospective studies have found that 25% of individuals developed PPPD 3-12 months after acute or episodic vestibular disorders (e.g. vestibular neuritis, benign paroxysmal positional vertigo (BPPV)). In 20% of cases, a vestibular migraine was a triggering event. Panic attacks or generalized anxiety preceded 15% of cases, and 7% were precipitated by an autonomic disorder. [1]
Diagnosis[edit | edit source]
All Barany Society Criteria must be met for a diagnosis of PPPD and thus is reliant on subjective history. PPPD symptom intensity can vary from distraction and energy levels but are overall chronic and persistent. This variability should not be mistaken for inauthenticity, as it is possible of the presentation.[1]
Barany Society Criteria for PPPD[2]: |
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A patient might also present with secondary psychiatric symptoms including fear of falling and avoidance behaviors, as well as functional gait abnormalities due to compensations such as body sway or hesitancy. Distracting motor tasks may be effective for the gait pattern to return to normal. This can demonstrate to the patient that it is possible to improve and return to normal gait patterns.
Pathophysiology[edit | edit source]
PPPD is theorized to develop by three main mechanisms:
- Stiffened postural control
- Favoring visual inputs rather than vestibular inputs to process spatial orientation information
- Failure to modulate the first two processes from higher cortical mechanisms
Outcome Measures[edit | edit source]
- Dizziness Handicap Inventory: measures a patient's perception of their disability related to their dizziness
Management / Interventions[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18:5-13.
- ↑ Staab JP, Eckhardt-Henn A, Horii A, Jacob R, Strupp M, Brandt T, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res. 2017; 27:191–208.