Extreme Frequency of Benign Paroxysmal Positional Vertigo Recurrences Unexplained by Any Known Risk Factors: A Case Report

Benign paroxysmal positional vertigo (BPPV) is a common vestibulopathy and involves failed dissolution and dislocation of calcium carbonate crystals into the semicircular canal. This causes short-lasting vertigo during changes in head position. Oftentimes, BPPV can be resolved within a single clinic visit, but secondary to many known risk factors, BPPV can recur. This case report follows a patient with extremely frequent recurrences despite a lack of known risk factors. A 55-year-old female experienced BPPV in December 2022, with successful canalith repositioning treatment from otolaryngology. On having a recurrence in March 2023, the patient underwent videonystagmography including caloric testing, and MRI, all of which showed normal findings besides left posterior-canal BPPV. From December 2022 to February 2024, the patient had 13 recurrences, each treated to resolution, confirmed by repeating positional tests and per subjective report for at least 2 weeks following. The incidence of BPPV recurrence is reported higher in females, however, this could not be interpreted as a causative factor. Though many other risk factors are documented in literature, this patient's history, demographics, imaging, and blood tests were all negative. This case report highlights a gap in knowledge of vestibular pathophysiology, as this patient's high rate of recurrence remains unexplained.