Benign Paroxysmal Positional Vertigo (BPPV) is a prevalent vestibular disorder marked by brief episodes of vertigo triggered by specific head movements. It results from the displacement of tiny calcium carbonate crystals (otoconia) within the inner ear’s semicircular canals. BPPV can be classified into various types, including:

• Posterior Canalithiasis: Displacement of crystals in the posterior semicircular canal.
• Posterior Cupulolithiasis: Crystals adhering to the cupula of the posterior canal.
• Lateral Canalithiasis: Crystals in the lateral (horizontal) semicircular canal.
• Lateral Cupulolithiasis: Crystals adhering to the cupula of the lateral canal.
• Anterior Canalithiasis: Crystals in the anterior (superior) semicircular canal.
• Apogeotropic Posterior Canalithiasis: A variant where the crystals stay in the proximal part of the posterior semicircular canal, causing atypical nystagmus that beats away from the ground when the head is in a hanging position. This presentation can be confusingly similar to the involvement of the anterior canal

Each type of BPPV requires specific diagnostic and treatment strategies to manage symptoms effectively and improve the patient’s quality of life.

For individuals with Traumatic Brain Injuries (TBIs), head trauma can dislodge these crystals, potentially leading to bilateral or mixed-type BPPV.

Many TBI patients with BPPV respond well to standard treatments like canalith repositioning manoeuvres (e.g., Epley manoeuvre). With appropriate treatment, patients often experience significant improvement or resolution of symptoms within a few sessions of treatment. However, the severity and nature of the TBI can impact BPPV prognosis. More severe brain injuries or complex TBIs may involve additional vestibular and neurological deficits, complicating the resolution of BPPV. Additionally, BPPV can recur in TBI patients, potentially more frequently or with different characteristics than in individuals without TBI. 

Monitoring and preventive strategies may be necessary.It is crucial for TBI patients experiencing dizziness or vertigo to undergo a thorough evaluation by a vestibular specialist. This evaluation will help diagnose the specific type of BPPV and differentiate it from other potential causes of symptoms. Tailoring treatment recommendations to the precise type of BPPV is essential for optimal management and recovery.