Understanding and Managing Trauma-Induced Vestibular Deficits

Abstract

OBJECTIVES:Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term "concussion" is often used to describe a minor form of traumatic brain injury. These often involve decelerative events to the head (e.g., flexion/extension injury) and can also cause damage to the vestibular system of the inner ear. MATERIALS AND METHODS:The European Society for Clinical Evaluation of Balance Disorders meets yearly and has proposed an investigation and analysis of the vestibular consequences of traumatic brain injury. This review paper outlines these discussions. RESULTS:The Society discussed all aspects of trauma-induced vestibular disorders along with diagnosis and management. They also assessed the diagnostic tests available to investigate these disorders. CONCLUSION:Trauma-induced vestibular disorders are difficult to manage, as our level of understanding of the pathology can be poor and anatomical localization can also be difficult. Accordingly, a definitive diagnosis cannot be pinpointed in many patients, but an extensive history taking is crucial to determine the nature and extent of vestibular involvement. Trauma can not only result in microtrauma to the central nervous system but can also significantly affect peripheral vestibular structures, particularly the otolith organs. The committee hopes that better understanding of trauma to the vestibular system, along with improvements in the field of radiology and vestibular assessments, will aid in more precise techniques of pinpointing pathology in order to develop an adapted treatment plan.

Evolution of postural control assessment: From dynamic posturography to virtual reality

“…By the time a patient sees a medical professional for a balance problem, attempting to define or locate the site of pathology can be challenging. Even when the site of injury is identified, symptoms and impairments may vary widely across patients ( 4 ).…”

“…This has become important as otolithic disorders can occur in an isolated fashion without other pathology ( 23 ). Individuals who have suffered head and neck trauma can also exhibit otolithic symptoms and it has been shown that the results of assessments in two different populations (i.e., vestibular dysfunction as a result of trauma and without trauma) are the same ( 4 , 21 , 24 ). A wide range of pharmacotherapeutics is available to manage symptoms of dizziness ( 18 ), but there are none that relieve the underlying cause.…”

Evaluation and management of paediatric vertigo

“…One of the most substantial differences in the management of vertigo over the last decade has been an increased understanding of the most common causes of paediatric dizziness [1 & ,3,7,10]. A nonexhaustive list is presented in Table 1 [59][60][61][62][63][64][65][66][67][68][69][70].…”

Exploring the relationship between sleep apnea and vestibular symptoms following traumatic brain injury

“…26,27 The etiology of such symptoms, especially following blast exposure, has been attributed to direct damage to the peripheral vestibular structures, which include the otolith organs, as well as damage to the central vestibular pathways common in diffuse axonal injury and white matter abnormalities. 28,29 There is robust evidence demonstrating that due to anatomical proximity of neurosensory tracts located within the central nervous system (CNS) (eg, the vestibulo-cerebellum, parietalvestibulo-cortex, vestibular thalamocortical, medial and lateral vestibulospinal and reticulospinal tracts) vestibular impairment can affect multiple other realms of CNS function, such as memory, cognition, mood, and sleep. [30][31][32][33][34][35][36] The incidence and prevalence of sleep disturbances, particularly obstructive sleep apnea (OSA), are disproportionally higher in veterans and service members (V/SM) than in the general population, 37 and have been largely attributed to deployment status, TBI, and comorbid mental health diagnoses such as posttraumatic stress disorder (PTSD).…”

“…The etiology of such symptoms, especially following blast exposure, has been attributed to direct damage to the peripheral vestibular structures, which include the otolith organs, as well as damage to the central vestibular pathways common in diffuse axonal injury and white matter abnormalities 28,29 . There is robust evidence demonstrating that due to anatomical proximity of neurosensory tracts located within the central nervous system (CNS) (eg, the vestibulo‐cerebellum, parietal‐vestibulo‐cortex, vestibular thalamocortical, medial and lateral vestibulospinal and reticulospinal tracts) vestibular impairment can affect multiple other realms of CNS function, such as memory, cognition, mood, and sleep 30–36 …”