Case 06 of 8 · Clinician · Presbyvestibulopathy vs BVP

Recurrent falls in an active 78-year-old

An active 78-year-old with three falls in six months, vHIT just above the PVP threshold.

CASE VIGNETTE

A 78-year-old retired schoolteacher reports three falls in the past six months — each occurring when walking on uneven ground or in low light. She has no rotational vertigo, no episodic dizziness, and no triggered positional symptoms. She walks five kilometres daily, plays golf weekly, and lives independently.

She reports that turning her head while walking now produces transient blurring of street signs, which has worsened gradually over two years.

On examination there is no nystagmus, no skew. Bedside HIT shows subtle catch-up saccades bilaterally but they are inconsistent. DVA loss is symmetric — 0.25 logMAR on rightward and leftward thrusts. Romberg is negative with eyes open, positive with eyes closed.

Formal testing: vHIT gain 0.65 right horizontal canal, 0.62 left. Caloric sum 18 °/s right, 16 °/s left. Audiogram shows symmetric mild-to-moderate high-frequency presbycusis. Hearing aids in use bilaterally.

Symmetric age-related sensorineural hearing loss frequently accompanies presbyvestibulopathy — both arise from age-related hair-cell ageing across the cochlea and vestibular end-organs. The audiometric pattern is supportive but not diagnostic of PVP.

DVA SIGNATUREMild

Presbyvestibulopathy (PVP) — at the BVP boundary

DVA loss: Symmetric 0.25 logMAR loss in both directions
Laterality: Bilateral symmetric
Asymmetry: None
Corroborating tests: vHIT 0.62-0.65 bilaterally (PVP range 0.6-0.8) · caloric sum 16-18°/s per side (PVP range 6-25°/s) · age ≥60 · chronic symptoms

Key signature: The PVP-vs-BVP question turns on the quantitative thresholds, not on patient age. vHIT 0.62-0.65 is in the PVP range (0.6-0.8); below 0.6 bilaterally would be BVP. This case is at the PVP boundary.

Test-battery findings

DVA loss — symmetric	0.25 logMAR both directions
vHIT gain	Right 0.65, left 0.62 (PVP range)
Caloric sum	Right 18°/s, left 16°/s (PVP range 6-25°/s)
Spontaneous nystagmus	Absent
Audiogram	Symmetric mild-to-moderate HF presbycusis
Romberg	Negative open, positive closed

Question

How should this clinical picture be labelled according to the Bárány Society criteria?

References

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Presbyvestibulopathy (PVP) — at the BVP boundary

Test-battery findings

Question

Further reading

References