Evaluation of Paraclinical Tests in the Diagnosis of Cervicogenic Dizziness

Abstract

This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.

Dizziness, Unsteadiness, Visual Disturbances, and Sensorimotor Control in Traumatic Neck Pain

“…67 Conversely, reproduction of symptoms during en bloc tests (ie, simultaneous trunk and head rotation) should indicate a noncervical cause. 49 Associated findings of musculoskeletal impairment in the cervical spine, especially the upper cervical spine, have been shown to be important in those with cervicogenic dizziness 67,86 ; however, this is usually present in those with traumatic neck pain and thus not specifically helpful for differential diagnosis in this group. A potential schema for differential diagnosis, possible subjective and objective test findings, and subsequent management that may be required are presented in the [ clinical commentary ]…”

“…Recently, it has been suggested that nystagmus of greater than 2°/s during sustained neck torsion positions may be an alternative and more sensitive method than SPNT to demonstrate these abnormalities. 67 However, this was done in individuals with cervicogenic diz-ziness and not specifically in those with traumatic neck pain.…”

“…87 Nevertheless, there are some emerging objective tests that may also help differential diagnosis of cervicogenic causes of the disturbances, with a cluster of tests likely to be more discriminatory than individual tests. 67 For example, tests of smooth pursuit, 111,119 balance, 133 and JPS 12 in torsion (head still, trunk rotated) may be useful in indicating the extent of the cervical spine contribution to the deficits. This is expected when signs and symptoms are increased when the individual is positioned in torsion compared to the neutral neck position.…”

“…However, while JPS testing is thought to be a measure of cervical proprioception, deficits have also been seen in those with vestibular pathology in some 114 but not other studies. 67 More recently, to better control for vestibular function, an alternative test of trunk relocation on a stable head has been developed (FIGURE 2). Although the test has promise to assist with differential diagnosis, additional research is required before it can be advocated for clinical and research use.…”

Revisión sobre el vértigo cervical

“…Esta propiocepción, que parte fundamentalmente de las carillas articulares de C1-C3 [11][12], participa también en el control postural (desequilibrio de origen cervical) y se supone responsable del reflejo cérvico-ocular (RCO), cuya presencia complementa al reflejo vestíbulo-ocular (RVO) en frecuencias lentas de movimiento [13]. La función de estos mecanorreceptores y nociceptores puede alterarse por traumatismo, fatiga muscular, cambios degenerativos o por efecto directo del dolor [14]. Pero falta de discernir, si las lesiones del cuello pueden llegar a influir, de manera significativa, en los sistemas oculomotor y vestibular humano [2].…”