Three Years with Dizziness
Peter Weisskopf, MD, assistant professor of otolaryngology-head and neck surgery at Mayo Clinic in Phoenix/Scottsdale, Ariz., described a 67-year-old woman who came to him complaining of three years of dizziness. She handed him a binder logging her symptoms by date and told him he was “the only one who can help me.”
Explore This IssueApril 2020
Dr. Weisskopf diagnosed her with persistent-postural and perceptual dizziness (PPPD), the second most common diagnosis seen in tertiary neurotology clinics. The condition can be chronic and disabling when it is missed, but treated successfully when it is caught, Dr. Weisskopf said.
PPPD involves dizziness, unsteadiness, or both for most days over three months or longer. The symptoms are there without a specific trigger, but can be made worse with an upright posture and exposure to moving visual stimuli. It also usually starts shortly after an event that causes acute vestibular symptoms, and the symptoms can’t be attributed more reasonably to some other disease or disorder (J Vestib Res. 2017;27:191-208).
Selective serotonin reuptake inhibitors, selective serotonin-norepinephrine reuptake inhibitors, physical therapy, and patient education are part of the treatment strategy, Dr. Weisskopf said.
Red flags that a condition is likely not PPPD, he said, include progressive symptoms that worsen over the course of years, an onset that’s indistinct, and symptoms that are constant regardless of factors that might bring them on.
Dr. Weisskopf said clinicians should remain aware of the possibility of PPPD.
“It’s actually tremendously common,” he said. “It’s just something that’s sort of easy for people to wave away.”
Thomas R. Collins is a freelance medical writer based in Florida.