Research Reports - Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction

Clin Neurol Neurosurg. 2017 Apr;155:17-19. doi: 10.1016/j.clineuro.2017.01.021.
Epub 2017 Feb 7.

Arshad Q(1), Roberts RE(1), Ahmad H(1), Lobo R(1), Patel M(1), Ham T(2), Sharp
DJ(2), Seemungal BM(3).

OBJECTIVE: We hypothesised that chronic vestibular symptoms (CVS) of imbalance
and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence
of multiple simultaneous vestibular diagnoses including both peripheral and
central vestibular dysfunction in individual patients increasing the chance of
missed diagnoses and suboptimal treatment; (ii) an impaired response to
vestibular rehabilitation since the central mechanisms that mediate
rehabilitation related brain plasticity may themselves be disrupted.
METHODS: We report the results of a retrospective analysis of both the
comprehensive clinical and vestibular laboratory testing of 20 consecutive THI
patients with prominent and persisting vestibular symptoms still present at least
6months post THI.
RESULTS: Individual THI patients typically had multiple vestibular diagnoses and
unique to this group of vestibular patients, often displayed both peripheral and
central vestibular dysfunction. Despite expert neuro-otological management, at
two years 20% of patients still had persisting vestibular symptoms.
CONCLUSION: In summary, chronic vestibular dysfunction in THI could relate to:
(i) the presence of multiple vestibular diagnoses, increasing the risk of
'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of
brain trauma which may impair brain plasticity mediated repair mechanisms. Apart
from alerting physicians to the potential for multiple vestibular diagnoses in
THI, future work to identify the specific deficits in brain function mediating
poor recovery from post-THI vestibular dysfunction could provide the rationale
for developing new therapy for head injury patients whose vestibular symptoms are
resistant to treatment. 

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