Objective: The aim of the study was to evaluate the true incidence, diagnosis, and treatment of
benign paroxysmal positional vertigo (BPPV) arising after whiplash injury and to distinguish this
type of posttraumatic vertigo from other types of dizziness complained after trauma.
Methods: This was a retrospective study comprising patients referred to our center after whiplash
injury. The patients were evaluated with neurotologic examination including bedside and
instrumental tests. A Dizziness Handicap Inventory evaluating the symptoms of patients was
submitted before and after treatment and was evaluated. The BPPV patients were separately
evaluated from those with cervicogenic vertigo, and a comparison between our data about idiopathic
BPPV was done.
Results: Eighteen patients of whiplash who had BPPV were evaluated. The mean age was 38.2
years. BPPV was the cause of vertigo in 33.9% of total whiplash patients. In 16 cases, the
posterior semicircular canal was involved; the lateral semicircular canal was involved in 2 cases.
The instrumental neurotologic assessment did not show any alteration of either vestibulospinal
reflexes or dynamic ocular movements. Duration of symptoms before treatment ranged from 3
to 26 days. A total of 55.5% of patients had relief from their symptoms after first repositioning
maneuver. The Dizziness Handicap Inventory score improved in all patients treated with
repositioning maneuvers, but no difference emerged with idiopathic BPPV data.
Conclusion: BPPV after whiplash injury could be unveiled with a simple bedside examination of
peripheral vestibular system, and a treatment could be done in the same session. The diagnosis of
posttraumatic BPPV is not different from the idiopathic form, but the treatment may require more
maneuvers to achieve satisfactory results
