Persistent Postural-Perceptual Dizziness (PPPD) is often secondary to vestibular disorders such as Benign Paroxysmal Positional Vertigo (BPPV) and Meniere's disease. However, PPPD secondary to vestibular disorders is often not correctly diagnosed.
The Niigata PPPD Questionnaire (NPQ) was created for to screen for PPPD, but its usefulness for evaluating the symptoms of PPPD has not yet been clearly elucidated.
A 49-year-old man with paroxysmal vertigo had been treated medically for 20 years as a case of Meniere's disease. He had had persistent dizziness 3 years before even in the intermittent periods [not sure what this means?] and he took long? leave of absence from his job one year prior to his first visit to us. As his score on the NPQ was 43 (cutoff score, 27), we suspected of PPPD secondary to Meniere's disease. Because the scores on the Hospital Anxiety and Depression Scale (HADS) were high, he was prescribed serotonin and noradrenaline reuptake inhibitors (SNRIs). In response to this treatment, his symptoms improved and his score on the NPQ dropped to 20. However, 3 months after he returned to work, the paroxysmal vertigo episodes reappeared. As the score on the NPQ remained as low as 26, we considered that the PPPD was well controlled and the paroxysmal vertigo represented flare-up of only Meniere's disease. Subsequently, the Meniere's attacks improved with lifestyle guidance alone.
In summary, we report a case of PPPD secondary to Meniere's disease in which the vertigo episodes were diagnosed as a manifestation of Meniere's disease for a long period of time, despite the presence of typical symptoms of PPPD. NPQ was useful for diagnosing PPPD and evaluating the cause of the vertigo in this patient, which remained stable even in the presence of frequent attacks of Meniere's disease.
