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Persistent postural perceptual dizziness (PPPD) refers to chronic, non-spinning vertigo and perceived dizziness with visual or motion hypersensitivity.^1,2 Diagnostic criteria include the presence of these symptoms on most days for three months or more that increase with upright posture, active or passive movement, or exposure to moving or complex visual stimuli.² PPPD is the most common chronic vestibular disorder in people aged 30-50 with 4:1 female predominance.¹ Triggers include peripheral vestibular diseases, central vertigo, anxiety disorders, and autonomic dysfunction.¹ Visual and somatosensory signals are stimulated as a physiological response to dizziness. These reactions cease when the trigger subsides, but a maladaptive cycle culminates in development of persistent vestibular symptoms in predisposed patients.² Neurological examination, visual evoked potentials and vestibular testing are typically normal.¹ Management includes cognitive behavioral therapy, vestibular reprogramming (visual/optokinetic motion desensitization, balance retraining), and medications such as venlafaxine or sertraline.^2,3

References:

1. Knight B, Bermudez F, Shermetaro C. Persistent Postural-Perceptual Dizziness. Updated October 3, 2022. In: StatPearls [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK578198/
2. Popkirov S, Staab JP, Stone J. Persistent postural-perceptual dizziness (PPPD): A common, characteristic and treatable cause of chronic dizziness. Pract Neurol. 2018;18(1):5-13; doi:10.1136/practneurol-2017-001809
3. Popkirov S, Stone J, Holle-Lee D. Treatment of persistent postural-perceptual dizziness (PPPD) and related disorders. Curr Treat Options Neurol. 2018;20(12):50; doi:10.1007/s11940-018-0535-0

Submitted by: Aarish Kaur Dhillon, MBBS, Mahatma Gandhi Medical College (Graduate), Neurology Rotation, Houston Medical Clerkship, Sugar Land, Texas and Faisal Khan, MD, DABSM, DABPN, Consultant Neurologist, Sugar Land, Texas.

Dr. Dhillon and Dr. Khan report no disclosures.