Arshad Q, Roberts R E, Ahmad H, Lobo R, Patel M, Ham T, Sharp D J, Seemungal B M
Academic Department of Neuro-Otology, Division of Brain Sciences, Charing Cross Hospital Campus, Imperial College, Fulham Palace Road, London, W6 8RF, UK.
The Computational, Cognitive and Clinical Neuroimaging Laboratory, Imperial College London, Hammersmith Hospital, London W12 0NN, UK.
Clin Neurol Neurosurg. 2017 Apr;155:17-19. doi: 10.1016/j.clineuro.2017.01.021. Epub 2017 Feb 7.
We hypothesised that chronic vestibular symptoms (CVS) of imbalance and dizziness post-traumatic head injury (THI) may relate to: (i) the occurrence of multiple simultaneous vestibular diagnoses including both peripheral and central vestibular dysfunction in individual patients increasing the chance of missed diagnoses and suboptimal treatment; (ii) an impaired response to vestibular rehabilitation since the central mechanisms that mediate rehabilitation related brain plasticity may themselves be disrupted.
We report the results of a retrospective analysis of both the comprehensive clinical and vestibular laboratory testing of 20 consecutive THI patients with prominent and persisting vestibular symptoms still present at least 6months post THI.
Individual THI patients typically had multiple vestibular diagnoses and unique to this group of vestibular patients, often displayed both peripheral and central vestibular dysfunction. Despite expert neuro-otological management, at two years 20% of patients still had persisting vestibular symptoms.
In summary, chronic vestibular dysfunction in THI could relate to: (i) the presence of multiple vestibular diagnoses, increasing the risk of 'missed' vestibular diagnoses leading to persisting symptoms; (ii) the impact of brain trauma which may impair brain plasticity mediated repair mechanisms. Apart from alerting physicians to the potential for multiple vestibular diagnoses in THI, future work to identify the specific deficits in brain function mediating poor recovery from post-THI vestibular dysfunction could provide the rationale for developing new therapy for head injury patients whose vestibular symptoms are resistant to treatment.
我们推测创伤性脑损伤（THI）后出现的慢性前庭症状（CVS），如失衡和头晕，可能与以下因素有关：（i）个体患者同时出现多种前庭诊断，包括外周和中枢前庭功能障碍，增加了漏诊和治疗不充分的可能性；（ii）对前庭康复的反应受损，因为介导康复相关脑可塑性的中枢机制本身可能受到破坏。
我们报告了对20例连续的THI患者进行综合临床和前庭实验室测试的回顾性分析结果，这些患者在THI后至少6个月仍存在明显且持续的前庭症状。
个体THI患者通常有多种前庭诊断，且在这组前庭患者中独特的是，常同时表现出外周和中枢前庭功能障碍。尽管有专家进行神经耳科学管理，但两年后仍有20%的患者存在持续的前庭症状。
总之，THI中的慢性前庭功能障碍可能与以下因素有关：（i）存在多种前庭诊断，增加了前庭“漏诊”导致症状持续的风险；（ii）脑外伤的影响，这可能损害脑可塑性介导的修复机制。除了提醒医生注意THI中存在多种前庭诊断的可能性外，未来确定介导THI后前庭功能障碍恢复不良的脑功能特定缺陷的工作，可为开发针对前庭症状难治的头部损伤患者的新疗法提供理论依据。
