3/6 video- PPPD - Clinical Features — The Postural, Motion & Visual Triad

The clinical picture of PPPD is remarkably consistent, and it is the basis of the diagnostic criteria. This episode turns the physiology into the bedside presentation. Patients describe a near-constant sense of dizziness, unsteadiness, swaying or rocking, frequently likened to being on a boat, rather than discrete rotational vertigo, present on most days and typically building from relative ease on waking to greater unsteadiness by evening. We work through the three exacerbating factors that define the syndrome and should be sought explicitly in every history: upright posture, active or passive self-motion, and exposure to moving or complex visual stimuli such as supermarkets, scrolling screens, patterned floors and traffic. We cover the typical precipitants: an acute or episodic vestibular disorder, vestibular migraine, concussion, dysautonomia, medical illness or a panic attack, and the secondary anxiety, fear of falling, avoidance and subjective brain fog that amplify disability. We show how the Niigata PPPD Questionnaire separates the three provoking factors and reveals a visual-dominant or motion-dominant phenotype that steers rehabilitation. Finally, and just as important, we define what PPPD is not: it does not cause true spinning attacks, spontaneous nystagmus or prominent vomiting, and when these appear an active disorder must be sought. Based on the ADC literature review 'Persistent Postural-Perceptual Dizziness (PPPD) - A Vestibular Physician's Deep Review'. For vestibular physicians, neuro-otologists, advanced ENT trainees and senior vestibular physiotherapists. Learn more at australiandizzinessclinics.com.