Lindsay-Hemenway Syndrome, Acute Vertigo Followed by BPPV: A Prospective Comparative Study

Lindsay-Hemenway syndrome (LHS) is characterized by an acute unilateral vestibular loss followed by ipsilateral posterior semicircular canal (PSC) benign paroxysmal positional vertigo (BPPV). Despite its clinical relevance, comparative data between LHS, isolated acute unilateral vestibulopathy (AUVP), and idiopathic PSC BPPV are uncommon. This work aims to compare vestibular function and clinical outcomes in patients diagnosed with LHS, isolated AUVP, and idiopathic PSC BPPV.

A multicenter longitudinal study was conducted between 2018 and 2025, enrolling 98 patients divided into three groups: LHS (n = 36), isolated AUVP (n = 30), and idiopathic PSC BPPV (n = 32). Vestibular evaluation was assessed through video head impulse test (vHIT), evaluation of spontaneous nystagmus, and Dix-Hallpike maneuver. Primary outcomes included vestibular gain at baseline and 6 months, presence and characteristics of corrective saccades, number of repositioning maneuvers required, and time to symptom resolution.

Patients with LHS showed significantly greater initial vestibular impairment in both affected and contralateral ears compared to isolated AUVP (p < 0.05) and demonstrated slower functional recovery at 6 months. Saccade amplitude was notably larger in LHS patients (p < 0.05), while latency and clustering were similar across groups. Spontaneous nystagmus persisted more frequently in the LHS cohort (OR 3.67). All LHS patients developed ipsilateral PSC BPPV, which required more repositioning maneuvers (p < 0.043) and presented a longer clinical course than idiopathic PSC BPPV (p < 0.05).

Lindsay-Hemenway syndrome involves more severe vestibular dysfunction, slower recovery, and more persistent BPPV than isolated AUVP or idiopathic PSC BPPV.