A traumatic brain injury (TBI) occurs when an external force causes brain dysfunction, such as a bump, blow, jolt to the head, or an object penetrating the skull. Vertigo is a sensation that you or your surroundings are spinning or moving when there is no actual motion. Following a TBI, many individuals experience vertigo, which can significantly impact their daily lives.
A TBI can disrupt the delicate balance system through various mechanisms. The vestibular system, located in the inner ear, includes semicircular canals that detect rotational head movements and otolith organs that sense linear movements and gravity. A forceful impact can directly damage these inner ear structures, their sensory hair cells, or the vestibular nerve, sending confusing signals to the brain.
Beyond direct inner ear injury, a TBI can also affect the brain’s central processing centers responsible for balance. The brainstem, cerebellum, and certain pathways in the cerebral cortex integrate sensory information from the eyes, inner ears, and body. Damage to these areas, such as from diffuse axonal injury, can impair the brain’s ability to interpret balance signals correctly, leading to persistent dizziness and difficulty coordinating movements.
Secondary effects following a TBI can also contribute to vertigo. Post-concussion syndrome often includes headaches, dizziness, and balance problems. Autonomic nervous system dysfunction, which regulates involuntary bodily functions, can cause sudden drops in blood pressure upon standing, leading to lightheadedness or vertigo. Vestibular migraines, characterized by recurrent episodes of vertigo with headaches, are another common consequence. Approximately half of individuals with a TBI report dizziness or balance issues during recovery.
Common Forms of Post-TBI Vertigo
One of the most frequently diagnosed types of vertigo after a TBI is Benign Paroxysmal Positional Vertigo (BPPV). This condition occurs when tiny calcium carbonate crystals, called otoconia, dislodge from their normal position in the inner ear and migrate into the semicircular canals. When these displaced crystals move during head position changes, they send abnormal signals, triggering brief but intense episodes of spinning vertigo, often lasting less than a minute. This form of vertigo is commonly provoked by movements like rolling over in bed, looking up, or bending down.
Another inner ear disturbance is labyrinthine concussion, a jarring injury to the fluid-filled structures of the inner ear. This can result in a sudden onset of continuous vertigo, sometimes with hearing loss. While initially constant, the vertigo can gradually become position-provoked as the brain adapts. A TBI can also contribute to post-traumatic Meniere’s disease, involving fluid buildup in the inner ear. Symptoms include episodic whirling vertigo, fluctuating hearing loss, ringing, and a feeling of fullness in the affected ear.
Vertigo originating from brain damage is classified as a central vestibular disorder. Unlike peripheral vertigo, which stems from the inner ear, central vertigo arises from issues within the brain’s balance centers, such as the brainstem or cerebellum. These disorders can manifest with more severe symptoms, including significant instability and difficulty walking.
Managing Vertigo After TBI
Diagnosing vertigo after a TBI begins with a comprehensive medical history and physical examination. Healthcare providers inquire about the injury’s nature, vertigo’s characteristics, and any accompanying symptoms. Specific tests, such as the Dix-Hallpike maneuver, identify positional vertigo like BPPV by observing eye movements. Imaging studies, including MRI or CT scans, may assess for structural damage within the brain or temporal bone fractures.
Treatment for post-TBI vertigo is tailored to the specific cause and often involves a multidisciplinary approach. Vestibular Rehabilitation Therapy (VRT) is an effective treatment, consisting of targeted exercises to retrain the brain and body to process balance information. This can include the Epley maneuver for BPPV to reposition dislodged crystals, gaze stabilization exercises, and habituation exercises to reduce sensitivity to movements that trigger dizziness. These exercises promote central nervous system compensation, allowing the brain to adapt to altered vestibular input.
Medication may be used to manage acute symptoms like nausea or severe spinning sensations, though it does not address the underlying cause. Lifestyle adjustments, such as avoiding sudden head movements, getting out of bed slowly, and identifying specific triggers, can help reduce the frequency and intensity of vertigo episodes. Individuals experiencing vertigo after a TBI should seek evaluation from a healthcare professional specializing in vestibular disorders for accurate diagnosis and appropriate treatment.