Review article analyzes pathophysiology, patient care of post-concussive dizziness

By Josh Wu. This article was initially published in our Concussion Update newsletter; please consider subscribing.

Over a million people report having mild traumatic brain injury or concussion (mTBI) per year. The second most persistent symptom reported is dizziness, ranging from feelings of “giddiness” to vertigo. A review article by Gerard J. Gianoli, published in Frontiers in Neurology, hypothesizes that the pathophysiology of dizziness stems from rotational forces that shear axons alongside increased pressure in the inner ear, both of which disrupt the body’s balancing mechanisms. 

Diagnosis of post-concussive dizziness can include non-vestibular, central vestibular, and peripheral vestibular causes.” Among the central disorders, the most implicated is concussion itself. It has been reasonably assumed that diffuse axonal injury of the central vestibular pathways could affect the vestibular system, causing dizziness.” However, symptoms initially attributed to central vestibular causes could actually be attributed to peripheral vestibular causes, likely due to improved diagnosis of peripheral vestibular function in the past years.

Furthermore, the identification of vestibular disorders is typically not diagnosed immediately with the onset of symptoms. Most cases of dizziness after concussions (85%-90%) should resolve on their own within the first three weeks, even without treatment. However, if this problem doesn’t resolve within three weeks, patients should seek further diagnostics and potentially vestibular rehabilitation therapy. See our page on Vestibular Therapy.