Paxman Eric, Stilling Joan, Mercier Leah, Debert Chantel T
Department of Clinical Neurosciences, Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
BMJ Case Rep. 2018 Nov 5;2018:bcr-2018-226698. doi: 10.1136/bcr-2018-226698.
A 61-year-old man sustained a mild traumatic brain injury (mTBI) following a pedestrian versus vehicle traffic accident. Post injury, he began to experience symptoms including light-headedness, spatial disorientation, nausea, fatigue and prominent dizziness brought on by postural change, physical activity or eye movements. Symptoms of dizziness persisted for over 5 years, despite numerous extensive and rigorous vestibular and vision therapy regimens. All investigations suggested normal peripheral and central vestibular functioning. The patient underwent 10 sessions of repetitive transcranial magnetic stimulation (rTMS) treatment, with stimulation of the left dorsolateral prefrontal cortex at 70% of resting motor threshold and a frequency of 10 Hz. Dizziness symptom severity and frequency were reduced by greater than 50% at 3 months post treatment, with a clinically significant reduction of dizziness disability from 40 to 21 points on the Dizziness Handicap Inventory. We propose rTMS as a safe, effective and cost-effective treatment option for patients who experience persistent post-traumatic dizziness secondary to mTBI.
一名61岁男性在行人与车辆交通事故后遭受轻度创伤性脑损伤（mTBI）。受伤后，他开始出现包括头晕、空间定向障碍、恶心、疲劳以及由姿势改变、体力活动或眼球运动引发的明显眩晕等症状。尽管接受了大量广泛且严格的前庭和视力治疗方案，眩晕症状仍持续了5年多。所有检查均提示外周和中枢前庭功能正常。该患者接受了10次重复经颅磁刺激（rTMS）治疗，刺激左侧背外侧前额叶皮层，刺激强度为静息运动阈值的70%，频率为10赫兹。治疗后3个月，眩晕症状的严重程度和发作频率降低了50%以上，眩晕残障量表评分从40分降至21分，有临床意义的显著改善。我们建议，对于mTBI继发持续性创伤后眩晕的患者，rTMS是一种安全、有效且具有成本效益的治疗选择。
