Gattu Ramtilak, Akin Faith W, Cacace Anthony T, Hall Courtney D, Murnane Owen D, Haacke E Mark
a Department of Diagnostic Radiology , Wayne State University School of Medicine , Detroit , MI , USA.
b Vestibular Laboratory, James A. Quillen VA Medical Center, Mountain Home , Johnson City , TN , USA.
Brain Inj. 2016;30(12):1501-1514. doi: 10.1080/02699052.2016.1219056.
Case reports are presented on four Veterans, aged 29-46 years, who complained of chronic dizziness and/or postural instability following blast exposures. Two of the four individuals were diagnosed with mild traumatic brain injury and three of the four were exposed to multiple blasts. Comprehensive vestibular, balance, gait, audiometry and neuroimaging procedures were used to characterize their injuries.
Vestibular assessment included videonystagmography, rotary chair and cervical and ocular vestibular evoked myogenic potentials. Balance and gait testing included the sensory organization test, preferred gait speed and the dynamic gait index. Audiometric studies included pure tone audiometry and middle-ear measurements. Neuroimaging procedures included high resolution structural magnetic resonance imaging, susceptibility-weighted imaging and diffusion-tensor imaging.
Based on the neuroimaging and vestibular and balance test results, it was found that all individuals had diffuse axonal injuries and all had one or more micro-hemorrhages or vascular anomalies. Three of the four individuals had abnormal vestibular function, all had abnormally slow walking speeds and two had abnormal gait and balance dysfunction.
The use of contemporary neuroimaging studies in conjunction with comprehensive vestibular and balance assessment provided a better understanding of the pathophysiology and pathoanatomy of dizziness following blast exposures than standard vestibular and balance testing alone.
本文报告了4名年龄在29至46岁之间的退伍军人的病例，他们在爆炸暴露后出现慢性头晕和/或姿势不稳。4人中2人被诊断为轻度创伤性脑损伤，4人中有3人经历了多次爆炸。采用了全面的前庭、平衡、步态、听力测定和神经影像学检查来描述他们的损伤情况。
前庭评估包括视频眼震图、转椅试验以及颈性和眼性前庭诱发肌源性电位检查。平衡和步态测试包括感觉组织测试、偏好步态速度和动态步态指数。听力测定研究包括纯音听力测定和中耳测量。神经影像学检查包括高分辨率结构磁共振成像、磁敏感加权成像和弥散张量成像。
根据神经影像学以及前庭和平衡测试结果，发现所有个体均有弥漫性轴索损伤，且均有一处或多处微出血或血管异常。4人中有3人前庭功能异常，所有人步行速度均异常缓慢，2人存在异常步态和平衡功能障碍。
与仅进行标准的前庭和平衡测试相比，结合当代神经影像学研究与全面的前庭和平衡评估，能更好地了解爆炸暴露后头晕的病理生理学和病理解剖学。
