Wiki Vertigo

Vertigo in patients with brain injuries: A case study

Case Study: Vertigo in a Patient with Traumatic Brain Injury

Patient Profile

• Name: John Doe
• Age: 32 years
• Gender: Male
• Medical History: No significant prior medical history; physically active and healthy prior to injury.
• Incident: The patient sustained a moderate traumatic brain injury (TBI) in a car accident six weeks prior to presentation. He experienced loss of consciousness for approximately 10 minutes at the scene.

Presenting Symptoms

• The patient presented to the clinic with complaints of persistent vertigo, dizziness, and imbalance.
• He reported episodes of vertigo that occurred daily, lasting from a few seconds to several minutes.
• Associated symptoms included tinnitus in the left ear, difficulty concentrating, and increased sensitivity to light and noise.
• He also mentioned frequent headaches, particularly in the occipital region.

Evaluation

1. Clinical Examination:
   • Neurological examination revealed no focal deficits. Cranial nerve function was intact.
   • The patient demonstrated mild difficulty with balance during Romberg testing.
2. Vestibular Assessment:
   • The Dix-Hallpike maneuver was performed, which was negative for BPPV.
   • Head thrust tests showed compensatory eye movements, indicating possible vestibular dysfunction.
   • The Fukuda stepping test revealed significant deviation to the left, suggesting a possible vestibular imbalance.
3. Audiometric Testing:
   • Pure tone audiometry revealed normal hearing thresholds bilaterally. However, there were signs of possible cochlear involvement given the patient’s tinnitus.
4. Imaging:
   • A CT scan of the head was performed, showing mild contusions in the right temporal lobe but no significant structural abnormalities.
   • An MRI of the brain was conducted to rule out any other potential lesions, which confirmed the CT findings.

Diagnosis

The clinical presentation, along with the vestibular and imaging findings, led to a diagnosis of post-traumatic vertigo secondary to traumatic brain injury. This condition is characterized by vestibular dysfunction following head trauma, which can manifest as vertigo, imbalance, and other sensory disturbances.

Treatment Plan

1. Vestibular Rehabilitation Therapy (VRT):
   • The patient was referred to a vestibular rehabilitation specialist for a tailored rehabilitation program, focusing on balance exercises, habituation exercises, and gaze stabilization exercises.
2. Medication:
   • The patient was prescribed meclizine to help manage acute episodes of vertigo.
   • NSAIDs were recommended for headache management as needed.
3. Education:
   • The patient received education regarding TBI recovery, including the importance of gradual return to activities and avoidance of sudden head movements that might exacerbate symptoms.
   • Lifestyle modifications were discussed, such as maintaining hydration and a consistent sleep schedule to promote recovery.
4. Follow-Up:
   • The patient was scheduled for follow-up visits every 4-6 weeks to monitor progress and adjust treatment as necessary.

Outcome

• At the two-month follow-up visit, the patient reported a significant reduction in the frequency and severity of vertigo episodes.
• He was actively participating in the vestibular rehabilitation program and had made notable improvements in balance and stability.
• Headaches were less frequent and manageable with NSAIDs.
• The tinnitus remained but was reported as less bothersome, and the patient felt more confident in his ability to resume daily activities.

Conclusion

This case highlights the importance of a comprehensive evaluation in patients with vertigo following a brain injury. The multidisciplinary approach, including vestibular rehabilitation, medication management, and patient education, proved effective in addressing the patient’s symptoms and improving his quality of life. Regular follow-up is essential in monitoring recovery and adjusting treatment plans accordingly. Further research is needed to better understand the mechanisms underlying post-traumatic vertigo and to develop more targeted therapies for affected individuals.

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