Persistent postural perceptual dizziness following stroke: the risk factors
Reviewed by Victor Osei-Lah

The primary motivation for the study, as stated by the authors, was that the factors behind persistent postural perceptual dizziness (PPPD) have not been clearly determined in stroke patients. To that end, a prospective study of adults presenting to a Neurology Stroke Centre was undertaken over a 3-year period. Of the 400 acute stroke patients with vestibular symptoms, 284 met the strict inclusion criteria. Of note, only patients with mild stroke as defined by the National Institutes of Health Stroke Scale (NIHSS), were included. Patients with moderate to severe stroke were likely to have significant residual neurological deficits that might confound vestibular perception and, therefore, were excluded. A number of validated questionnaires were used to assess the impact of dizziness, comorbidities, quality of life and psychological factors. Assessment was done during admission and at 6 months after the stroke. The vestibular symptoms at presentation were vertigo (45%), dizziness (71%), vestibulo-visual symptoms (10%) and postural symptoms (60%). Ninety patients had nystagmus but the characteristics were not specified. Cerebral infarcts in the posterior circulation territory accounted for 82.7% (235/284) of the strokes, the rest being haemorrhagic. The sites of infarction were within the PICA territory (30.6%), followed by the pons (27%), medulla (17%), thalamus (10%), occipital lobe (6.7%) and others. In 18% and 14% of cases, there was significant anxiety and depression respectively at discharge from hospital. At follow-up, 35 patients (12.3%) fulfilled the PPPD criteria. Compared to the non-PPPD patients, the PPPD group had statistically significant higher DHI scores, poorer quality of life, moderate to severe living disability due to dizziness, higher risk of falls, higher risk of anxiety and depression at discharge. Further analyses showed that the key PPPD predictors were medulla stroke, cerebellar stroke in PICA territory and clinically significant anxiety at discharge. These were independent factors. In addition, the authors reported PPPD patients were more likely to have a high risk of falls and decreased quality of life. They concluded that stroke patients at risk of developing PPPD should be evaluated as early as possible to prevent the impact on long-term functional recovery and quality of life.

Incidence, risk factors, and comorbidities of persistent postural-perceptual dizziness after stroke: A prospective study of 284 cases.
Li J, Bai X, Fang R, et al.
J VESTIB RES
2025;36(2):100–6.