Vestibular consequences of mild traumatic brain injury and blast exposure: a review

Abstract

The purpose of this article is to review relevant literature on the effect of mild traumatic brain injury (mTBI) and blast injury on the vestibular system. Dizziness and imbalance are common sequelae associated with mTBI, and in some individuals, these symptoms may last for six months or longer. In war-related injuries, mTBI is often associated with blast exposure. The causes of dizziness or imbalance following mTBI and blast injuries have been linked to white matter abnormalities, diffuse axonal injury in the brain, and central and peripheral vestibular system damage. There is some evidence that the otolith organs may be more vulnerable to damage from blast exposure or mTBI than the horizontal semicircular canals. In addition, benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder following head injury that is treated effectively with canalith repositioning therapy. Treatment for (non-BPPV) mTBI-related vestibular dysfunction has focused on the use of vestibular rehabilitation (VR) augmented with additional rehabilitation methods and medication. New treatment approaches may be necessary for effective otolith organ pathway recovery in addition to traditional VR for horizontal semicircular canal (vestibulo-ocular reflex) recovery.

Glial Activation in the Thalamus Contributes to Vestibulomotor Deficits Following Blast-Induced Neurotrauma

“…Clinical studies have indicated that thalamic damage transpires following both blast and impact-related injuries and have an impact on motor and cognition impairments ( 67 ). Neurosensory outcomes such as vestibulomotor impairment have become increasingly common in military personnel, Veterans and civilians diagnosed with TBI ( 1 , 61 ). However, those exposed to blast events appear to have a unique set of outcomes compared to those involved in impact-related injuries.…”

Analysis of Free-Living Mobility in People with Mild Traumatic Brain Injury and Healthy Controls: Quality over Quantity

“…An array of symptoms accompany acute mild Traumatic Brain Injury (mTBI), including subtle motor, cognitive and sensory abnormalities (vestibular, visual and somatosensory). [1][2][3][4][5] These deficits persist in a majority of adults with mTBI, who experience symptoms >3 months following initial injury 6 that directly impact quality of life. [7][8][9] Sub-clinical, non-resolving problems with motor functions, such as balance 10 or gait, 11 are common following an mTBI, relate to cognitive 12 and sensory 13 deficits, and have implications for limiting everyday function.…”

Assessment of Long-Term Effects of Sports-Related Concussions: Biological Mechanisms and Exosomal Biomarkers

“…The accumulation of NFTs has been observed in the deep sulci in frontal and temporal cortices and along cortical blood vessels of individuals with CTE and is thought to contribute significantly to the long-term development of neurodegeneration in individuals with mTBIs (Omalu, 2014;McKee et al, 2016;Washington et al, 2016;Mez et al, 2017;Alosco et al, 2018). Dizziness and imbalance, both common symptoms of mTBI, have been linked to white matter abnormalities and diffuse axonal injuries (Cecil et al, 1998), in addition to vestibular system damage (Akin et al, 2017). Diffuse axonal injuries following mTBIs have also been reported in experimental animal models of TBI (Mannix et al, 2013).…”