Brain correlates of persistent postural-perceptual dizziness: A review of neuroimaging studies

Iole Indovina, Luca Passamonti, Viviana Mucci, Giuseppe Chiarella, Francesco Lacquaniti, Jeffrey P. Staab

Research output: Contribution to journalReview articlepeer-review


Persistent postural-perceptual dizziness (PPPD), defined in 2017, is a vestibular disorder characterized by chronic dizziness that is exacerbated by upright posture and exposure to complex visual stimuli. This review focused on recent neuroimaging studies that explored the pathophysio-logical mechanisms underlying PPPD and three conditions that predated it. The emerging picture is that local activity and functional connectivity in multimodal vestibular cortical areas are decreased in PPPD, which is potentially related to structural abnormalities (e.g., reductions in cortical folding and grey-matter volume). Additionally, connectivity between the prefrontal cortex, which regulates attentional and emotional responses, and primary visual and motor regions appears to be increased in PPPD. These results complement physiological and psychological data identifying hypervigilant postural control and visual dependence in patients with PPPD, supporting the hypothesis that PPPD arises from shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks that overweigh visual over vestibular inputs and increase the effects of anxiety-related mechanisms on locomotor control and spatial orientation.

Original languageEnglish (US)
Article number4274
JournalJournal of Clinical Medicine
Issue number18
StatePublished - Sep 2021


  • Chronic subjective dizziness
  • Neuroimaging
  • Persistent postural-perceptual dizziness
  • Phobic postural vertigo
  • Visual dependency
  • Visually induced dizziness

ASJC Scopus subject areas

  • Medicine(all)


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