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Vestibular Disorders

Triple Benign Paroxysmal Positional Vertigo and the Strength of Remote Video-Based Management

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JAMA Neurology

Published Online: January 9, 2023

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Article Information and Disclosures

Michael Strupp, MD¹;

Vergil Mavrodiev¹;

Nicolina Goldschagg, MD¹

Author Affiliations

¹Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Germany

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A 72-year-old woman had recurrent short-lasting episodes of positional vertigo sometime after a head trauma. When she came to our hospital 6 months later, her bedside examination was normal, with namely no evidence for positional vertigo or nystagmus. Laboratory testing showed a reduced caloric response on the right side (side difference, 70%) and reduced cervical vestibular evoked myogenic potentials on the right. Since she lives 160 miles away from our hospital, she was instructed to send videos of her eye movements during positional maneuvers. Based on these videos, right-sided posterior canal benign paroxysmal positional vertigo (BPPV) canalolithiasis was diagnosed 2 days later (Video, A). After the diagnosis was made, the patient performed the SémontPLUS treatment maneuvers.¹ The correctness of the performance of the maneuvers was also documented (Video, B). After performing the SémontPLUS maneuvers 9 times a day, she was free of episodes of BPPV after 2 days.

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Article Information

Published Online: January 9, 2023. doi:10.1001/jamaneurol.2022.4861

Correction: This article was corrected on March 13, 2023, to fix a misspelling in the surname of the second author, Vergil Mavrodiev.

Corresponding Author: Michael Strupp, MD, University of Munich, Marchioninistrasse 15, Munich 81377, Germany (michael.strupp@med.uni-muenchen.de).

Conflict of Interest Disclosures: Dr Strupp reported speaker’s honoraria from Abbott, Actelion, Auris Medical, Biogen, Eisai, Grünenthal, GSK, Henning Pharma, Interacoustics, Johnson & Johnson, Merck, MSD, NeuroUpdate, Otometrics, Pierre-Fabre, TEVA, UCB, and Viatris; grants from Decibel Therapeutics, Cures Within Reach, and Heel; consulting fees from Abbott, Actelion, AurisMedical, Bulbitec, Heel, IntraBio, Sensorion, and Vertify; and a patent as an investor and shareholder of IntraBio and licensed patents for Acetyl-DL-leucine. He is Joint Chief Editor of the Journal of Neurology, Editor in Chief of Frontiers of Neuro-otology, and Section Editor of F1000 and distributes M-glasses and the positional vertigo app. Dr Goldschagg reported personal fees from IntraBio. No other disclosures were reported.

Additional Contributions: We thank the patient and videographer for granting permission to publish this information.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.