Post-traumatic peripheral vestibular disorders (excluding positional vertigo) in workers following head injury

Priyanka Misale,Sasan Dabiri,John Rutka,Fatemeh Hassannia,Tom Brandstaetter

doi:10.1038/s41598-021-02987-5

Abstract

Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. There is however paucity in the literature about other peripheral vestibular disorders post-head injury. This article provides an overview of other causes of non-positional dizziness post-head trauma from our large institutional experience. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. All subjects had a detailed neurotological history and examination and vestibular testing including video nystagmography, video head impulse testing (or a magnetic scleral search coil study), vestibular-evoked myogenic potentials, and audiometry. Imaging studies included routine brain and high-resolution temporal bone CT scans and/or brain MRI. Based on a database of 4291 head-injured workers with dizziness, 244 were diagnosed with non-positional peripheral vertigo. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The incidence of Meniere’s disease in the post-traumatic setting did not appear greater than found in the general population. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere’s disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed.

Highlights

Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness
Considerations include a spectrum of clinical entities such as recurrent vestibulopathy (RV)[4,5], delayed endolymphatic hydrops (DEH)[6,7], post-traumatic endolymphatic hydrops or posttraumatic Meniere’s disease (MD)[8]
Typical benign paroxysmal positional vertigo (BPPV) included those with posterior semicircular canal (PSCC) canalolithiasis

Summary

Introduction

Benign paroxysmal positional vertigo has typically been reported to be the most common cause of post-traumatic dizziness. The UHN WSIB Neurotology database (n = 4291) between 1998 and 2018 was retrospectively studied for those head-injured workers presenting with non-positional peripheral vestibular disorders. Recurrent vestibulopathy (RV) was the most common cause of non-positional post-traumatic vertigo. The clinical spectrum pertaining to recurrent vestibulopathy, Meniere’s disease, delayed endolymphatic hydrops, drop attacks, superior semicircular canal dehiscence syndrome, and uncompensated peripheral vestibular loss are discussed. While post-traumatic BPPV is well described, the literature remains sparse documenting other disorders of peripheral vestibular dysfunction encountered in the post-head injury setting. In this paper we comment on the other peripheral vestibular disorders (exclusive of BPPV or “other” forms of positional vertigo) identified from our University Health Network (UHN), Province of Ontario, Workplace Safety and Insurance Board (WSIB) database.

Methods

Results

Discussion

Conclusion