title: Evidence of central and peripheral vestibular pathology in blast-related traumatic brain injury.
abstract: OBJECTIVE
  To prospectively assay the vestibular and oculomotor systems of blast-exposed service members with traumatic brain injury (TBI).
  
  
  METHODS
  Prospective, nonblinded, nonrandomized descriptive study.
  
  
  METHODS
  Tertiary care facility (Department of Defense Medical Center).
  
  
  METHODS
  Twenty-four service members recovering from blast-related TBI sustained in Iraq or Afghanistan.
  
  
  METHODS
  Focused history and physical, videonystagmography (VNG), rotational chair, cervical vestibular-evoked myogenic potentials, computerized dynamic posturography, and self-report measures.
  
  
  RESULTS
  Vestibular testing confirms a greater incidence of vestibular and oculomotor dysfunction in symptomatic (vestibular-like dizziness) personnel with blast-related TBI relative to asymptomatic group members. VNG in the symptomatic group revealed abnormal nystagmus or oculomotor findings in 6 of 12 subjects tested. Similarly, rotational chair testing in this group revealed evidence of both peripheral (4/12) and central (2/12) vestibular pathology. By contrast, the asymptomatic group revealed less vestibular impairment with 1 of 10 rotational chair abnormalities. The asymptomatic group was further characterized by fewer aberrant nystagmus findings (4/12 abnormal VNGs). Computerized dynamic posturography testing revealed no significant differences between groups. Self-report measures demonstrated differences between groups.
  
  
  CONCLUSIONS
  Vestibular function testing confirms a greater incidence of peripheral vestibular hypofunction in dizzy service members with blast-related TBI relative to those who are asymptomatic. Additionally, oculomotor abnormalities and/or nystagmus consistent with central involvement were present in 10 of the 24 study participants tested. The precise cause of these findings remains unknown.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA. Matthew.scherer@us.army.mil
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Scherer
authors.forename: Holly
authors.initials: H
authors.lastname: Burrows
authors.forename: Robin
authors.initials: R
authors.lastname: Pinto
authors.forename: Philip
authors.initials: P
authors.lastname: Littlefield
authors.forename: Louis M
authors.initials: LM
authors.lastname: French
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Tarbett
authors.forename: Michael C
authors.initials: MC
authors.lastname: Schubert
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000503:physiopathology*; D001930:Brain Injuries / Q000503:physiopathology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009802:Oculomotor Nerve / Q000503:physiopathology; D061220:Oculomotor Nerve Injuries; D011446:Prospective Studies; D012027:Reflex, Vestibulo-Ocular / Q000502:physiology*; D014724:Vestibular Function Tests; D014725:Vestibular Nerve / Q000293:injuries* / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000503:physiopathology