Elsevier

Neurologic Clinics

Volume 33, Issue 3, August 2015, Pages 661-668
Neurologic Clinics

Early Diagnosis and Treatment of Traumatic Vestibulopathy and Postconcussive Dizziness

https://doi.org/10.1016/j.ncl.2015.04.004Get rights and content

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Key points

  • Neurosensory disorders are the most common sequelae of mild traumatic brain injury (mTBI), and among these, balance disorders are the ones most frequently seen.

  • Balance disorders seen after mTBI can be diagnosed and treated, and whereas some resolve with time, many of these disorders require treatment.

  • Vestibular rehabilitation is one of the most important treatment modalities available for patients with mTBI and has been documented to be successful in this patient group.

  • Untreated mTBI can

The definition of mild traumatic brain injury

There are a variety of definitions of mTBI. Although these definitions were developed by health organizations and government agencies, there is no consensus definition. For a detailed discussion of this particular topic, the reader is referred to the Centers for Disease Control and Prevention (CDC) Web site,5 which is an excellent resource for traumatic brain injury (TBI)- and mTBI-related health issues. For this article, the authors have adopted a basic functional definition of TBI as follows:

  • 1.

Epidemiology

It is difficult to draw reliable conclusions from the existing epidemiologic data regarding prevalence and long-term consequences of mTBI. The lack of consensus in definitions and the fact that many mTBI cases go unreported makes epidemiologic classification problematic. It is clear that the reported prevalence of mTBI is increasing. Several reports focused on selected populations, such as high-school athletes9 or emergency departments (EDs), over limited time frames10, 11 do give estimates of

Balance disorders after blast injuries

There have been several studies examining balance disorders after blast exposure. An explosives detonation produces a shock wave, a blast wind, and an electromagnetic pulse. Primary blast injury is produced by shock wave propagation through tissue. The leading edge of the shock wave, the blast front, is an overpressure that propagates supersonically; it is followed by a negative pressure termed the underpressure. Reflections off environmental surfaces can produce more complicated exposures and

Balance disorders after blunt head injury

Blunt head injury has a well-known association with balance disorders.24, 25, 26 Suarez and colleagues24 demonstrated that the dizziness was one of the most frequent symptoms seen after mild head injury in a civilian setting. Meanwhile, Grubenhoff25 examined the relative frequency of specific types of dizziness as a function of age in an mTBI group and found that younger individuals were more susceptible to potentially treatable causes of balance disorders. Hoffer and colleagues27 examined

Diagnosis

Diagnosis of mTBI has always presented challenges. This fact is true in part because many of the symptoms are self-reported with variable intensity over time. As discussed earlier, balance disorders present a unique window into the brain for diagnosing mTBI. One of the most interesting and promising areas includes examining optokinetic and vestibular reflexes in response to a variety of visual and vestibular challenges. Working with Neuro Kinetics, Inc (Pittsburgh, PA, USA), the authors have

Treatment

Advances in treatment of mTBI have been relatively slow to develop. In general, treatment can be classified as pharmacotherapy and rehabilitation. To date, the only pharmacotherapy that has demonstrated effectiveness is N-acetyl cysteine (NAC). NAC was found to be an effective countermeasure for blast-induced mTBI.38 Working in a combat environment, a double-blinded placebo-controlled study revealed that NAC was far more effective than a control medicine at reducing symptoms measured at 7 days

Summary

mTBI is an increasingly common public health issue. Most of the acute, subacute, and chronic symptoms are neurosensory in nature and most commonly cause dizziness. Recognizing dizziness in this population is important because it provides a starting point for management of a difficult clinical entity, which can be measured objectively and treated effectively. Vestibular rehabilitation remains the standard treatment of mTBI, although clinical trials in the effectiveness of both rehabilitation and

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