PDF(Pubmed)
Abstract：
OBJECTIVE: This study aims to provide an overview of dizziness post head injury in those with prominent features for central vestibular dysfunction (CVD) in comparison to those with a post-traumatic peripheral vestibular etiology.
METHODS: Retrospective.
METHODS: University Health Network (UHN) Workplace Safety and Insurance Board (WSIB) database from 1988 to 2018 were evaluated for post-traumatic dizziness.
METHODS: The UHN WSIB neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for head-injured workers presenting with features for CVD associated with trauma. All patients had a detailed neurotological history and examination, audiovestibular testing that included video nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMPs). Imaging studies including routine brain and high-resolution temporal bone computed tomography (CT) scans and/or intracranial magnetic resonance imaging (MRI) were available for the majority of injured workers.
RESULTS: Among 4291 head-injured workers with dizziness, 23 were diagnosed with features/findings denoting CVD. Complaints of imbalance were significantly more common in those with CVD compared to vertigo and headache in those with peripheral vestibular dysfunction. Atypical positional nystagmus, oculomotor abnormalities and facial paralysis were more common in those with CVD.
CONCLUSIONS: Symptomatic post-traumatic central vestibular injury is uncommon. It occurred primarily following high-impact trauma and was reflective for a more severe head injury where shearing effects on the brain often resulted in diffuse axonal injury. Complaints of persistent imbalance and ataxia were more common than complaints of vertigo. Eye movement abnormalities were highly indicative for central nervous system injury even in those with minimal change on CT/MRI.
METHODS: Retrospective.
METHODS: University Health Network (UHN) Workplace Safety and Insurance Board (WSIB) database from 1988 to 2018 were evaluated for post-traumatic dizziness.
METHODS: The UHN WSIB neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for head-injured workers presenting with features for CVD associated with trauma. All patients had a detailed neurotological history and examination, audiovestibular testing that included video nystagmography (VNG) and cervical vestibular-evoked myogenic potentials (cVEMPs). Imaging studies including routine brain and high-resolution temporal bone computed tomography (CT) scans and/or intracranial magnetic resonance imaging (MRI) were available for the majority of injured workers.
RESULTS: Among 4291 head-injured workers with dizziness, 23 were diagnosed with features/findings denoting CVD. Complaints of imbalance were significantly more common in those with CVD compared to vertigo and headache in those with peripheral vestibular dysfunction. Atypical positional nystagmus, oculomotor abnormalities and facial paralysis were more common in those with CVD.
CONCLUSIONS: Symptomatic post-traumatic central vestibular injury is uncommon. It occurred primarily following high-impact trauma and was reflective for a more severe head injury where shearing effects on the brain often resulted in diffuse axonal injury. Complaints of persistent imbalance and ataxia were more common than complaints of vertigo. Eye movement abnormalities were highly indicative for central nervous system injury even in those with minimal change on CT/MRI.
摘要：
目的：本研究旨在提供与创伤后外周前庭病因相比，具有中央前庭功能障碍（CVD）突出特征的头部损伤后头晕的概述。
方法：回顾性。
方法：对1988年至2018年的大学健康网络（UHN）工作场所安全与保险委员会（WSIB）数据库进行了创伤后头晕评估。
方法：对1998年至2018年的UHNWSIB神经数据库（n=4291）进行了回顾性研究，研究对象为头部受伤的工人，这些工人表现出与创伤相关的CVD特征。所有患者都有详细的神经病史和检查，包括视频眼震描记术（VNG）和宫颈前庭诱发肌源性电位（cVEMPs）的前庭听力测试。大多数受伤工人都可以进行成像研究，包括常规大脑和高分辨率颞骨计算机断层扫描（CT）扫描和/或颅内磁共振成像（MRI）。
结果：在4291名头部受伤的头晕工人中，23例被诊断为具有表示CVD的特征/发现。与患有周围前庭功能障碍的眩晕和头痛相比，患有CVD的患者对失衡的投诉明显更常见。非典型位置性眼震,眼球运动异常和面瘫在CVD患者中更为常见。
结论：有症状的创伤后中央前庭损伤并不常见。它主要发生在高冲击创伤之后，并且反映了更严重的头部损伤，其中对大脑的剪切作用通常导致弥漫性轴索损伤。持续失衡和共济失调的投诉比眩晕的投诉更常见。即使在CT/MRI变化最小的人群中，眼球运动异常也高度表明中枢神经系统损伤。
方法：回顾性。
方法：对1988年至2018年的大学健康网络（UHN）工作场所安全与保险委员会（WSIB）数据库进行了创伤后头晕评估。
方法：对1998年至2018年的UHNWSIB神经数据库（n=4291）进行了回顾性研究，研究对象为头部受伤的工人，这些工人表现出与创伤相关的CVD特征。所有患者都有详细的神经病史和检查，包括视频眼震描记术（VNG）和宫颈前庭诱发肌源性电位（cVEMPs）的前庭听力测试。大多数受伤工人都可以进行成像研究，包括常规大脑和高分辨率颞骨计算机断层扫描（CT）扫描和/或颅内磁共振成像（MRI）。
结果：在4291名头部受伤的头晕工人中，23例被诊断为具有表示CVD的特征/发现。与患有周围前庭功能障碍的眩晕和头痛相比，患有CVD的患者对失衡的投诉明显更常见。非典型位置性眼震,眼球运动异常和面瘫在CVD患者中更为常见。
结论：有症状的创伤后中央前庭损伤并不常见。它主要发生在高冲击创伤之后，并且反映了更严重的头部损伤，其中对大脑的剪切作用通常导致弥漫性轴索损伤。持续失衡和共济失调的投诉比眩晕的投诉更常见。即使在CT/MRI变化最小的人群中，眼球运动异常也高度表明中枢神经系统损伤。
