Post-concussive Dizziness: A Review and Clinical Approach to the Patient

Gianoli, Gerard J.

doi:10.3389/fneur.2021.718318

Cited by 11 publications

(10 citation statements)

References 41 publications

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“…Dizziness was included as it is a common complaint after head trauma, second only to headache. 23 Our definition also included adulthood brain injury since the age of 15 years ( n = 115). The original data included a variable indicating whether the man experienced a serious head injury or a high fever of 103° Fahrenheit (or 39.4°C) or higher.…”

Section: Methodsmentioning

confidence: 99%

Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital

et al. 2022

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Background Acquired brain injury (ABI) is a serious problem that disproportionately affects individuals in correctional services, but relatively little is known about ABI risks and correlates in forensic psychiatric services. Methods We conducted a retrospective chart review of all admissions to a high secure forensic hospital in Ontario, Canada from January 2009 to December 2012 ( n = 637) and collected data on ABI, psychiatric diagnoses, developmental disadvantage, criminal offending, and in-hospital aggression. A k-means cluster analysis was employed to assess risk factors by which men with ABI could be identified and multivariate general linear models were used to identify ABI-related differences in offending history and in-hospital aggression. Results One-fifth of the men had a documented ABI indicator. Based on our cluster analysis, ABI was more likely to be identified by greater adverse childhood experiences (ACEs), more health problems from pregnancy to childhood, and lower socioeconomic status, suggesting that ABI within the forensic context is associated with greater developmental disadvantage. Men with ABI had more serious pre-admission offences, but not more serious admission offences or in-hospital aggression. Men with ABI were more likely than those without to have higher scores on the Violence Risk Appraisal Guide or to be diagnosed with mood and personality disorders, and less likely to have a schizophrenia diagnosis, suggesting an association between ABI and general mental health pathologies but not with psychotic illness. Conclusions The disadvantage of ABI among men in forensic psychiatric hospitals is most likely evinced in antisocial behaviour rather than serious mental illness. Given that ACEs are likely to precede or co-occur with ABI, strategies that mitigate ACEs hold promise for ABI prevention.

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Section: Methodsmentioning

confidence: 99%

Adverse Childhood Experiences and Offending as a Function of Acquired Brain Injury Among Men in a High Secure Forensic Psychiatric Hospital

et al. 2022

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“…Participants were secured to the tilt table with their feet flush to a footboard to minimize movement and potential artifact during the tilt; blood pressure and heart rate were assessed using a non-invasive beat-to-beat blood pressure device (Nexfin Model 2, Edwards Lifesciences/BMEYE, Amsterdam, Netherlands; and CNAP Monitor 500, CNSystems Medizintechnik GmbH, Graz, Austria). [47][48][49][50] A sling was used to maintain their upper extremity at heart level for the duration of testing. An external brachial blood pressure was also used to verify the accuracy of continuous measurements at regular intervals throughout the testing, coincident with symptom checks.…”

Section: Balance and Mobility Performancementioning

confidence: 99%

“…However, single-item responses that ask patients to rate overall dizziness are nonspecific and are thus not recommended as standalone assessment measures. [7][8][9][10] The Dizziness Handicap Inventory (DHI) was developed as a structured self-report assessment of situation-dependent impact of dizziness symptoms, 11 and is recommended over symptom severity ratings. 7,12 Yet, while the DHI provides insight into the daily impact of dizziness, it does not yield information on the underlying cause.…”

Section: Introductionmentioning

confidence: 99%

“…Despite common treatment models assigning dizziness symptoms to a 'vestibular'-based symptom subtype / cluster, [13][14][15][16] self-reported disability due to dizziness cannot be easily attributed to a single system; vestibular, oculomotor, balance and mobility, and autonomic dysfunction can all be independent contributors to dizziness. 7,[17][18][19][20][21][22][23] The vestibular system functions to sense movement and orientation of the head and body in space, which, if altered, can produce symptoms of dizziness. 13,24 Within the vestibular domain, a recent study found no clear association between patient-reported dizziness or imbalance and peripheral vestibular dysfunction, suggesting deficits in central sensorimotor integration are more prevalent after mTBI than peripheral vestibular disorders.…”

Section: Introductionmentioning

confidence: 99%

“…7–10 The Dizziness Handicap Inventory (DHI) was developed as a structured self-report assessment of situation-dependent impact of dizziness symptoms, 11 and is recommended over symptom severity ratings. 7,12 Yet, while the DHI provides insight into the daily impact of dizziness, it does not yield information on the underlying cause.…”

Section: Introductionmentioning

confidence: 99%

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A Multimodal Assessment of the Heterogeneous Nature of Post-mTBI Dizziness

Pelo

Gaudette

Millsap

et al. 2022

Preprint

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Dizziness after mild traumatic brain injury (mTBI) is commonly attributed to impairment within the vestibular system. However, oculomotor, mobility, and autonomic dysfunction can also contribute to patient-reported dizziness. The purpose of this preliminary study was to examine whether a multimodal battery of assessments could help explain patient-reported dizziness after mTBI. Twenty-three participants with concussion-related symptoms completed the Dizziness Handicap Inventory (DHI) to evaluate burden imposed by dizziness on daily activities and a battery of tests designed to incorporate domains that have been shown to contribute to dizziness (e.g., vestibular, oculomotor, balance and mobility, and autonomic dysfunction). Specific outcomes included quantitative variables obtained from: Vestibular Ocular Motor Screening (VOMS); standing for 30 seconds with feet together, eyes closed, with hands on their hips on both firm and foam surfaces; walking for one minute at a comfortable pace; and a Head-up Tilt (HUT) Test. Univariate associations between DHI and individual measures were assessed, and a backwards-stepwise regression model determined the multi-variable association. There were no strong associations and only a few moderate associations between individual functional measure and DHI total score. A total of eight variables had univariate correlation coefficients larger than 0.20 in magnitude. The final model from the backwards-stepwise procedure explained 69% of the variance in DHI and retained only three variables: peak turning speed from the one-minute walk; mean blood pressure (MBP) during the HUT; and the total VOMS score. Isolated assessments of individual domains of function have weak-to-moderate associations with post-mTBI dizziness. Conversely, a multivariable model that contained measures of mobility, autonomic function, and symptomatic complaints to vestibular and ocular provocation explained 69% of the variance in dizziness. These results suggest that dizziness is physiologically heterogeneous in nature and support the use of multi-domain assessments in patients with dizziness after mTBI.

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