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Vertigo, Nystagmus and Traumatic Brain Injury


A common side effect of head trauma is vertigo. The victim of an automobile accident who experiences head trauma or whiplash frequently experiences vertigo. Vertigo is the sense that things are spinning around them. Many people have experienced vertigo, as a result of ear infections, medications, or acute alcohol toxicity (the room is spinning).

It is a highly unpleasant sensation, and can completely disrupt a person’s life. It can be intermittent and come on suddenly. There is often no easy treatment.

So what does it have to do with an eye doctor? Well, the symptoms are partially visual- objects seem to jerk back and forth (usually in a horizontal direction). Secondly, these patients have specific eye exam findings called nystagmus.

Nystagmus is usually a rapid beating of the eyes as the eyes look left and right. This can easily be detected by an experienced ophthalmologist who carefully evaluates for eye movement disorders. Other specialists can easily miss nystagmus and it is an important objective finding in a traumatic brain injury (TBI) patient.

Nystagmus can also be vertical (up and down ) or rotational (angular) but these are less common in trauma. The beating of the eyes can also occur at low frequency, but this is also uncommon in trauma.

There are many causes of nystagmus besides head trauma. Some individuals are born with this disorder (congenital nystagmus) and many people acquire the abnormal movement with medical problems of the inner ear or brain. It is important for the examiner to take a detailed history and do a careful exam to exclude nystagmus caused by other causes. Eye doctors are uniquely positioned in the medical community to make these subtle distinctions.

I do not wish to get into a detailed listing of all medical conditions associated with nystagmus. However, the eyes are tightly tied into the loop. Each time a person turns his/her head and neck, the eyes adjust immediately. Otherwise, our visual universe would be a very jerky place (think video filming).

Neurologists are frequently called to examine patients with vertigo and head trauma. Fortunately, vertigo usually fades after head trauma, but it can be chronic. Also, many patients who have risk factors for vertigo (migraines) can have their lives disrupted by head injury.

It is important to describe this finding in a medical report in as much detail as possible so changes is nystagmus over time can be measured. Prognosis is always important.

Dizziness after head injury is common. Dizziness is a general imbalance or unsteadiness. Vertigo is a more specific type of dizziness, and has more objective findings and has more objective medical impact. My message is consistent- don’t overlook having trauma patients examined by an eye doctor. Even if such patients have no internal eye injuries, eye movement disorders can be critical in defining visual impairment. The eyes need to move normally to see properly.

Oral medications can sometimes help. I have had a previous blog on Vision Therapy as an eye exercise program that can treat vertigo with associated eye movement disorders. An experienced eye care professional can make the necessary professional recommendations. Most importantly, victims of traumatic brain injury (TBI) should not be ignored .

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