Symptomatic and Asymptomatic Benign Paroxysmal Positional Vertigo Identified During Inpatient Traumatic Brain Injury Rehabilitation

OBJECTIVE: To determine the incidence of benign paroxysmal positional vertigo (BPPV) among adults with traumatic brain injury (TBI) undergoing inpatient rehabilitation using routine vestibular screening independent of symptom report, and to describe clinical presentation, canal characteristics, and response to canalith repositioning maneuvers. DESIGN: Retrospective cohort study. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Consecutive adults admitted for inpatient rehabilitation after TBI. METHODS: Medical records were retrospectively reviewed for all patients with traumatic brain injury admitted to inpatient rehabilitation who underwent standardized vestibular assessment as part of routine screening irrespective of dizziness complaints. BPPV was diagnosed based on documented positional nystagmus consistent with Bárány Society criteria. Incidence was defined as the proportion of patients diagnosed with BPPV among those who completed routine vestibular assessment during inpatient rehabilitation. Symptom status, canal involvement, and treatment outcomes were descriptively analyzed. RESULTS: Of 119 patients screened, 10 could not be reliably assessed and were excluded. Among 109 assessed patients, 49 were diagnosed with BPPV, yielding an incidence of 45.0% (95% CI: 35.4%-54.8%). Of the 49 patients with BPPV, 19 (38.8%) reported dizziness before vestibular assessment, 13 (26.5%) reported symptoms only during positional testing, 9 (18.4%) reported no subjective vertigo despite objective positional nystagmus, and 8 (16.3%) were unable to reliably report symptom status because of cognitive or communication impairment. Posterior canal involvement was most common (65.3%), followed by horizontal canal involvement (22.4%) and multiple-canal involvement (12.2%). Canalith repositioning maneuvers resulted in resolution in 95.9% of cases (95% CI: 86.0%-99.5%). Most patients (73.5%) resolved with a single session, 20.4% required 2 sessions, and 6.1% required 3 or more sessions (median 1 session; range 1-3). CONCLUSIONS: BPPV is a common complication of TBI during inpatient rehabilitation. Routine vestibular screening identified cases that would not have been detected through spontaneous symptom reporting alone, including individuals without subjective vertigo and those unable to reliably report symptoms.