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Post-Traumatic Dizziness

  • Otology: Vestibular Disorders (J Rutka, Section Editor)
  • Published:
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Abstract

Purpose of Review

Traumatic brain injury (TBI) is a significant cause of morbidity and to a lesser extent mortality yearly. Dizziness remains a common complaint, presenting in up to 80% of patients post-head injury. This has obvious physical and psychological consequences not only to the individual but also a significant economic impact on society as a whole. Despite much being written in the field of TBI including concussion and sports-related head injury, the effects of trauma on the vestibular system have had relatively little study. Large-scale population studies addressing dizziness in the context of head injury do not exist in the literature. This article aims to provide an overview of dizziness post-TBI. The results from a large prospective database from the University Health Network (UHN) Workplace Insurance and Safety Board (WSIB) Neurotology are presented.

Recent Findings

The results of the UHN WSIB Neurotology database (n = 3438 head-injured workers) from the Canadian province of Ontario (1998–2014) either suggested or diagnosed BPPV in 23% post-head injured workers. One hundred and forty-nine workers (4.3%) were diagnosed with other distinct forms of peripheral vestibular dysfunction; the most common episodic type (35% of 149 workers) being a recurrent vestibulopathy (RV). The study did not find a causative link in the TBI patients studied to support a diagnosis for post-traumatic Meniere’s as the incidence of the disease in this cohort was equal to that in the general population.

Summary

This article is intended to provide an overview of post-traumatic dizziness following TBI, to discuss generally recognized inner ear disorders post-head injury, the results from the UHN WSIB Neurotology database and to address some of the controversies in the field.

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Notes

  1. According to the 2016 US Veterans Administration/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Concussion-Mild Traumatic Brain Injury [2••], a TBI is defined as a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force and is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event:

    • Any period of loss or a decreased level of consciousness

    • Any loss of memory for events immediately before or after the injury (post-traumatic amnesia)

    • Any alteration in mental state at the time of the injury (i.e. confusion, disorientation, slowed thinking, alteration of consciousness/mental state)

    • Neurological deficits (e.g. weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient

    • Intracranial lesion

    Numerous guidelines have been written on the inclusion criteria for diagnosis of a mild traumatic brain injury (mTBI). Most concur that mTBI (while recognizing it as a complex pathophysiological process affecting the brain) clinically is associated with a Glasgow Coma Scale (GCS) of 13–15, resolution of post-traumatic amnesia within 24 h and a loss of consciousness for less than 30 min [3••].

  2. Laboratory vestibular testing at UHN included ENG/VNG and combinations of vestibular evoked myogenic potential testing (both o and cVEMPs), vestibular head impulse testing (vHIT) and magnetic scleral search coil (MSSC) studies. Their incorporation in the formal test battery depended when the technology was available in our unit.

  3. One should be careful when interchanging the word dizziness for vertigo and vice versa. By definition, all vertigo is considered dizziness but not all dizziness is considered vertigo—vertigo being largely confined to a feeling of hallucination/illusion of movement. In its episodic form, it would largely be considered to arise primarily from transient disruption of peripheral vestibular pathways and rarely from those central vestibular in origin.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada

    Simon Carr & John Rutka

  2. Toronto General Hospital, University Health Network, 200 Elizabeth Street, 8N-873, Toronto, Ontario, M5G 2C4, Canada

    John Rutka

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Correspondence to John Rutka.

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Conflict of Interest

Dr. Simon Carr and Dr. John Rutka declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclaimers

The UHN Research Ethics Board (REB) approved the analysis of study data presented under the Co-ordinated Approval Process for Clinical Research (14–8093).

Additional information

This article is part of the Topical Collection on Otology: Vestibular Disorders

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Carr, S., Rutka, J. Post-Traumatic Dizziness. Curr Otorhinolaryngol Rep 5, 142–151 (2017). https://doi.org/10.1007/s40136-017-0154-4

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