Posttraumatic dizziness

Posttraumatic dizziness

Posttraumatic dizziness is a common complaint after accidents. Vertigo can be present in up to 75% of patients after traumatic brain injury (TBI). Vestibular dysfunction can originate from the brain, the inner ear or both. Vertigo can lead to loss in balance and falls. It also impairs quality of life.

Trauma may result in a temporal bone fractures with hearing loss and vertigo. Milder forms of trauma to the ear can result in labyrinthine concussion, perilymph fistula (PLF), benign paroxysmal positional vertigo (BPPV), otolithic vertigo and secondary endolymphatic hydrops. These conditions can often lead to more long-term incapacitation than a fracture.

Vascular injuries can lead to stroke and damage to the inner ear. Vertebral artery dissection has been reported after chiropractic manipulation of the neck.

Whiplash and neck injuries can also result in dizziness. The role of the neck as part of the vestibulo spinal reflex (VSR) is undisputed. Whether an injury to the neck can cause dizziness is somewhat controversial and no diagnostic test for cervical vertigo exists.

The post concussion syndrome can occur in 15% of patients after mild brain injury. It is believed by some to occur after an injury to the brainstem as opposed to cerebral concussion. It consists of headaches, concentration problems, memory loss, emotional problems, irritability and dizziness. It may last for more than a year.

Persistent Postural-Perceptual Dizziness (PPPD) and other psychogenic forms of dizziness are often seen after head injuries. Even mild injuries may lead to permanent disability. This is commonly seen after motor vehicle accidents with legal implications and the possibility of secondary gain (malingering).

In the immediate period after a traumatic brain injury the emphasis is put on the life threatening injuries. Dizziness is usually expected. It is most likely to improve over time and resolve. The persistent, recurrent and new onset vertigo cases need investigation. Videonystagmography (VNG), rotation testing and computed dynamic posturography (CDP) are vital tools in assessing a patient. These tests can be performed at any stage after the accident.