(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance) (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019 – 31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with first ever attack of vertigo, patients with recurrent vertigo and dizziness; patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrary divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient's clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.

(1) Background: Persistent postural-perceptual dizziness (PPPD) is a syndrome described as secondary when it is the consequence of an organic disorder (s-PPPD) or primary when no somatic triggers cannot be identified. We evaluated a group of patients diagnosed as s-PPPD with Benign Positional Paroxysmal Vertigo (BPPV) as the main somatic trigger with the aim to identify predictive clinical elements of evolution towards PPPD.; (2) Methods: We compared the clinical characteristics of the 51 patients with s-PPPD having as trigger a BPPV (group 1) with 107 subjects diagnosed as BPPV but with no evolution in PPPD (control group). Results: A significant statistical difference in the mean age was found between s-PPPD and the non-s-PPPD group. The latency between the onset of BPPV and the final diagnosis was 25.2 days in the group 1 and 12.8 days in the control group; (4) Conclusions: The parameters mostly involved as potential precipitants of PPPD after BPPV are represented by the age of the patients and a long latency between the onset of BPPV and the final diagnosis: the mean age of the subjects who developed a PPPD following BPPV is significantly higher. These findings lead us to emphasize the importance of an early identification and treatment of BPPV, especially in older patients.

Benign Paroxysmal Positional Vertigo (BPPV) represents the most frequent cause of peripheral vertigo. In most cases it is successfully treated by canalith repositioning procedure (CRP), but it is often followed by a continuous lightheadedness in absence of vertigo or nystagmus (residual dizziness, RD). Our aim is to describe the clinical effectiveness and the urine metabolomics profile treating these patients by a polyphenol compound supplementation. We enrolled 30 patients reporting RD after BPPV successfully treated using CRP. A supplementation with a Polyphenol compound was administered for 60 days, and patients were evaluated after 30 and 60 days of treatment by a self-administered questionnaires (Visual Analog Scales for Dizziness and Nausea, Dizziness Handicap Inventory, DHI) and by urine metabolomics analysis performed by 1H-NMR spectroscopy and multivariate followed by univariate analysis. Most patients reported an excellent or good efficacy of RD with a significant decrease for VAS and DHI values. The metabolomics analysis identified six significant metabolites related to the treatment: 1-methylnicotinamide, anserine, Hippurate, lysine, methyl succinate, and urea indicating an inflammatory activities and antioxidant properties of the polyphenol compound. These preliminary data suggest that supplementation with a polyphenol compound cold induces some metabolic changes that can help recover RD. However, the future steps will require confirmation with a more significant cohort of patients and an extension of the metabolomic evaluation to other problems concerning the different clinical aspects of BPPV, such as the high relapse found in a high percentage of patients.