頭頚部外傷後症候群症例の検討

Abstract

Over the past 5 years, 34 cases of dizziness caused by head and neck injury were experienced at the Department of Otolaryngology, Kanto Rosai Hospital. For the causes of injury, 15 of them were from traffic accident, 10 were from falls, 4 involved violence, 3 were sports, and 2 involved accidents at work. Twenty five cases involved occipital or temporal bone (several cases involved the neck), 6 cases were cervical injury (so called whiplash injury), and 6 cases were facial bone injury. All cases of facial injury had disordered maxillary and zygomatic bone. 10 cases required laboratory studies only, and the other 24 cases required diagnosis and treatment. In laboratory tests, abnormal findings were observed in 33% of cases in the carolic test, and 33% in the optokinetic pattern and eye tracking test. Findings of nystagmus were observed in 60% of cases. For the diagnosis of dizziness, 15 cases involved middle ear disorder, 7 were benign proximal positional vertigo, and 8 were cervical vertigo. For these patients, treatment involved medicine, rehabilitation and counseling. Almost all patients recovered within 1 year, but 6 cases were unchanged and continued treatment. Four of these 6 cases had a complication of recurrent headache or ear pain. Another 2 cases had trouble in the office or with communication.Dizziness in several patients concerned cervical injury. We considered that dizziness was caused by the difference of flow between both vertebral arteries. The mechanism of the difference in flow was concerned with the sympathetic nerve and receptor in deep muscle in the neck.