title: Patients with chronic dizziness following traumatic head injury typically have multiple diagnoses involving combined peripheral and central vestibular dysfunction.
abstract: OBJECTIVE
  We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular dysfunction in individual patients increasing the chance of missed diagnoses and suboptimal treatment; (ii) an impaired response to vestibular rehabilitation since the central mechanisms that mediate rehabilitation related brain plasticity may themselves be disrupted.
  
  
  METHODS
  We report the results of a retrospective analysis of both the comprehensive clinical and vestibular laboratory testing of 20 consecutive THI patients with prominent and persisting vestibular symptoms still present at least 6months post THI.
  
  
  RESULTS
  Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persisting vestibular symptoms.
  
  
  CONCLUSIONS
  In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of 'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment.
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: Q
authors.initials: Q
authors.lastname: Arshad
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Roberts
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: H
authors.initials: H
authors.lastname: Ahmad
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: R
authors.initials: R
authors.lastname: Lobo
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.affiliation: The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
authors.forename: T
authors.initials: T
authors.lastname: Ham
authors.affiliation: The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
authors.forename: D J
authors.initials: DJ
authors.lastname: Sharp
authors.affiliation: Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK. Electronic address: b.seemungal@imperial.ac.uk.
authors.forename: B M
authors.initials: BM
authors.lastname: Seemungal
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D004244:Dizziness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D004856:Postural Balance; D012189:Retrospective Studies; D015837:Vestibular Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D014722:Vestibule, Labyrinth / Q000503:physiopathology
keywords: Chronic dizziness; Traumatic head injury; Vestibular dysfunction