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Traumatic Brain Injury - Post-Traumatic Vertigo and Dizziness

Robert Karns

Dizziness and vertigo are common symptoms following traumatic brain injury. Although these symptoms can resolve within a brief period of time, many patients symptoms last much longer and impede the ability to return to work in full functioning. Post -traumatic vertigo and dizziness caused by traumatic brain injury can have many different causes including the following:

• Benign Paroxysmal Positional Vertigo (BPPV) - This is the most common type of severe dizziness and is very common after head injury. This is a vestibular disorder and occurs when microscopic calcium crystals known as otoconia become dislodged from their normal position in the inner ear causing extreme dizziness. There is therapy that can be done known as the Epley maneuver or repositioning maneuver that puts the crystals back where they go in the inner ear. BPPV occurs when the head is moved in certain positions. This leads to a false sense that the head and body are spinning and nausea and vomiting can occur.

• Labyrinthine or Inner Ear Concussion - A labyrinthine concussion results from trauma rupturing portions of the membranous inner ear or bleeding or traumatic ischemia. This is a vestibular injury that causes extreme dizziness.

• Post-Traumatic Meniere's Syndrome - Post-traumatic Meniere's disease or syndrome is a vestibular injury that is a disorder of the inner ear causing episodes of vertigo (dizziness), tinnitus (noise in the ear) and hearing changes. Post-traumatic Meneire's Syndrome is caused by bleeding into the inner ear or disturbance of fluid in the ear caused by the trauma.

• Temporal Bone Fracture - The temporal bone borders the inner ear. Temporal bone fractures can be caused by motor vehicle accidents, falls, assaults and other trauma. A temporal bone fracture results in severe dizziness after the injury and can be diagnosed with a CT scan. In addition, a temporal bone fracture can cause hearing loss and/or peripheral facial weakness.

• Perilymph Fistula - A perilymph fistula is a tear or defect in one or both of the small, thin membranes between the middle and inner ear. This can occur by trauma and is a vestibular injury. These membranes separate the middle ear from the fluid filled inner ear. The symptoms of perilymph fistula include dizziness and vertigo, in-balance, nausea and vomiting. It can also cause ringing in the ears (tinnitus) and may cause hearing loss.

• Central Nervous System Traumatic Injury - In addition to all of the above vestibular injuries caused by trauma, vertigo and dizziness and in-balance can be caused by traumatic brain injury. Trauma to the pontomedullary region of the brain can cause dizziness. In addition, diffuse axonal injury (white injury) and/or contusion to the brain stem or cerebellum can cause dizziness as well.

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