First episode of "probable benign paroxysmal positional vertigo, spontaneously resolved": a comparative and follow-up study.

PURPOSE: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. A specific variant, "probable BPPV, spontaneously resolved" (pBPPVsr), is characterized by a history of positional vertigo without nystagmus or symptoms during clinical examination, leading clinicians to assume spontaneous resolution. This study was performed to compare the characteristics of patients with pBPPVsr and non-spontaneously resolved BPPV; to estimate the spontaneous resolution rate over time; to assess the sensitivity of the Dix-Hallpike test; and to monitor long-term recurrences and complications. METHODS: Prospective, multicenter observational study. Patients with a first episode of BPPV were recruited over one year and followed for an additional year. Inclusion criteria included a first-ever BPPV episode and no prior treatment. Patients were classified as pBPPVsr if no symptoms or nystagmus were elicited during positional tests. Group characteristics were compared, spontaneous resolution rates were estimated using Kaplan-Meier curves, and the Dix-Hallpike test sensitivity and complication rates (recurrence, headache, neck pain, falls, and PPPD) were assessed through scheduled follow-up calls. RESULTS: Spontaneous resolution occurred in 17-30% of cases, more frequently in younger patients without hypertension or diabetes, and typically within the first days of symptom onset. Dix-Hallpike test sensitivity was estimated at 97.7%. During follow-up, pBPPVsr patients more frequently triggered clinical suspicion of recurrence, and showed higher rates of new-onset headaches and neck pain. CONCLUSION: pBPPVsr accounts for a substantial proportion of first-episode vertigo cases. Despite apparent resolution, patients remain at risk of recurrence and complications.