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Vestibular dysfunction in acute traumatic brain injury

Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are crypt...

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Autores principales: Marcus, Hani J., Paine, Heidi, Sargeant, Matthew, Wolstenholme, Susie, Collins, Katie, Marroney, Natalie, Arshad, Qadeer, Tsang, Kevin, Jones, Brynmor, Smith, Rebecca, Wilson, Mark H., Rust, Heiko M., Seemungal, Barry M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765474/
https://www.ncbi.nlm.nih.gov/pubmed/31201499
http://dx.doi.org/10.1007/s00415-019-09403-z
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author Marcus, Hani J.
Paine, Heidi
Sargeant, Matthew
Wolstenholme, Susie
Collins, Katie
Marroney, Natalie
Arshad, Qadeer
Tsang, Kevin
Jones, Brynmor
Smith, Rebecca
Wilson, Mark H.
Rust, Heiko M.
Seemungal, Barry M.
author_facet Marcus, Hani J.
Paine, Heidi
Sargeant, Matthew
Wolstenholme, Susie
Collins, Katie
Marroney, Natalie
Arshad, Qadeer
Tsang, Kevin
Jones, Brynmor
Smith, Rebecca
Wilson, Mark H.
Rust, Heiko M.
Seemungal, Barry M.
author_sort Marcus, Hani J.
collection PubMed
description Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies.
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spelling pubmed-67654742019-10-09 Vestibular dysfunction in acute traumatic brain injury Marcus, Hani J. Paine, Heidi Sargeant, Matthew Wolstenholme, Susie Collins, Katie Marroney, Natalie Arshad, Qadeer Tsang, Kevin Jones, Brynmor Smith, Rebecca Wilson, Mark H. Rust, Heiko M. Seemungal, Barry M. J Neurol Original Communication Traumatic brain injury (TBI) is the commonest cause of disability in under-40-year-olds. Vestibular features of dizziness (illusory self-motion) or imbalance which affects 50% of TBI patients at 5 years, increases unemployment threefold in TBI survivors. Unfortunately, vestibular diagnoses are cryptogenic in 25% of chronic TBI cases, impeding therapy. We hypothesized that chronic adaptive brain mechanisms uncouple vestibular symptoms from signs. This predicts a masking of vestibular diagnoses chronically but not acutely. Hence, defining the spectrum of vestibular diagnoses in acute TBI should clarify vestibular diagnoses in chronic TBI. There are, however, no relevant acute TBI data. Of 111 Major Trauma Ward adult admissions screened (median 38-years-old), 96 patients (87%) had subjective dizziness (illusory self-motion) and/or objective imbalance were referred to the senior author (BMS). Symptoms included: feeling unbalanced (58%), headache (50%) and dizziness (40%). In the 47 cases assessed by BMS, gait ataxia was the commonest sign (62%) with half of these cases denying imbalance when asked. Diagnoses included BPPV (38%), acute peripheral unilateral vestibular loss (19%), and migraine phenotype headache (34%), another potential source of vestibular symptoms. In acute TBI, vestibular signs are common, with gait ataxia being the most frequent one. However, patients underreport symptoms. The uncoupling of symptoms from signs likely arises from TBI affecting perceptual mechanisms. Hence, the cryptogenic nature of vestibular symptoms in TBI (acute or chronic) relates to a complex interaction between injury (to peripheral and central vestibular structures and perceptual mechanisms) and brain-adaptation, emphasizing the need for acute prospective, mechanistic studies. Springer Berlin Heidelberg 2019-06-14 2019 /pmc/articles/PMC6765474/ /pubmed/31201499 http://dx.doi.org/10.1007/s00415-019-09403-z Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Communication
Marcus, Hani J.
Paine, Heidi
Sargeant, Matthew
Wolstenholme, Susie
Collins, Katie
Marroney, Natalie
Arshad, Qadeer
Tsang, Kevin
Jones, Brynmor
Smith, Rebecca
Wilson, Mark H.
Rust, Heiko M.
Seemungal, Barry M.
Vestibular dysfunction in acute traumatic brain injury
title Vestibular dysfunction in acute traumatic brain injury
title_full Vestibular dysfunction in acute traumatic brain injury
title_fullStr Vestibular dysfunction in acute traumatic brain injury
title_full_unstemmed Vestibular dysfunction in acute traumatic brain injury
title_short Vestibular dysfunction in acute traumatic brain injury
title_sort vestibular dysfunction in acute traumatic brain injury
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6765474/
https://www.ncbi.nlm.nih.gov/pubmed/31201499
http://dx.doi.org/10.1007/s00415-019-09403-z
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