Vestibular system dysfunction in patients after mild traumatic brain injury

Abstract

Introduction. In the literature there are some discrepancies concerning the occurrence of vertigo and disequilibrium, as well as the type of vestibular dysfunction in patients after mild traumatic brain injury (MTBI). Objective. The aim of the study was to assess the type of vestibular system dysfunction in MTBI patients after injury at baseline and 6-month follow-up. Materials and method. From a group of 188 patients with vertigo/dizziness and balance instability after MTBI, prospective analysis in 50 patients with abnormal videonystagmography (VNG) were conducted. Anamnesis, otoneurological examination, self-assessed Dizziness Handicap Inventory (DHI) and VNG test were carried in each patient twice-at baseline and after 6 months. Results. A significant improvement in the DHI total score (9.8 points, p<0.001) and in the subscales was found after 6 months. At baseline, VNG test showed the peripheral vestibular system dysfunction in 19 cases (38%), central vestibular dysfunction in 20 patients (40%) and mixed vestibular dysfunction in 11 cases (44%). After 6 months, the VNG records normalization was observed in 19 patients (38%), an improvement was significantly more frequently related to peripheral disorders, compared to central ones (p<0.001). Conclusions. In patients after mild traumatic brain injury, about one-fourth of them had vestibular system dysfunction with the same frequency of peripheral, central and mixed lesions in videonystagmography. Subjective post-traumatic symptoms and vestibular system dysfunction in patients after MTBI decrease after 6-month follow-up. However, more than half of patients still have abnormal VNG results, which indicate dysfunction of the central vestibular system.

Predictive Accuracy of the Sport Concussion Assessment Tool 3 and Vestibular/Ocular-Motor Screening, Individually and In Combination: A National Collegiate Athletic Association–Department of Defense Concussion Assessment, Research and Education Consortium Analysis

“…13,21,45 Only 1 subtest of the SCAT (ie, modified BESS) targets a component of the vestibular system, the vestibulospinal tract. Commonly affected vestibulo-ocular functions—such as vergence, pursuits, saccades, the vestibulo-ocular reflex (VOR), and visual motion sensitivity, also known as VOR cancellation 13,53-55 —are not assessed, and the SCAT symptom evaluation has only 2 questions addressing visual disturbances (visual blur and light sensitivity). This is surprising given that up to 56% of individuals with TBI 13 develop vestibulo-ocular sequelae, including vergence, accommodation, and oculomotor dysfunction.…”

Challenging the Vestibular System Affects Gait Speed and Cognitive Workload in Chronic Mild Traumatic Brain Injury and Healthy Adults

“…Our third objective was to examine if vestibular function, measured by gaze stability, was associated with gait speed. Vestibulo-ocular dysfunction is common after mTBI ( 19 , 55 , 56 ), therefore we expected to see greater DVA loss in the mTBI group compared to controls. We found DVA loss of >0.2 logMAR in 56% of controls and 65% of mTBI participants.…”

Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System

“…Parietal regions are involved in processing vestibular information for the perception of self-motion [111]. In cases of post-concussion or mTBI vestibular dysfunction, vestibular impairment causes a myriad of symptoms related to imbalance and disorientation, which often manifests as dizziness/vertigo and/or lightheadedness and may be accompanied by nausea as well [112,113]. For non-hospitalized TBI patients, vestibular function testing detects abnormalities in somewhere between about 30 to 60% of those tested and symptoms may continue for in excess of one year in 10 to 15% of patients with a mild concussion [10,[114][115][116][117].…”