From the Guidelines
Spinning sensations with movements in concussion patients are primarily caused by damage to the vestibular system, which controls balance and spatial orientation. When a concussion occurs, the brain's sudden movement within the skull can injure the vestibular structures in the inner ear or disrupt the neural pathways that process balance information [ 1 ]. This condition, known as post-concussion vestibular dysfunction, affects how the brain interprets motion and position. The spinning sensation (vertigo) typically worsens with head movements because damaged vestibular structures send incorrect signals to the brain about the body's position and movement.
Some key points to consider in the management of spinning sensations with movements in concussion patients include:
- The importance of early diagnosis and intervention to prevent long-term complications [ 1 ]
- The use of symptom-based tools to assess the presence and severity of a concussion [ 1 ]
- The potential for visual processing problems to contribute to spinning sensations [ 1 ]
- The effectiveness of vestibular rehabilitation therapy in improving symptoms [ 1 ]
Additionally, visual processing problems following concussion can contribute to these symptoms, as the brain struggles to integrate visual information with balance signals. Recovery usually involves vestibular rehabilitation therapy, which includes specialized exercises to retrain the brain to properly interpret balance signals [ 1 ]. Patients should avoid activities that worsen symptoms initially but gradually reintroduce movement under professional guidance. Most patients see improvement within weeks to months as the brain compensates for the injury through neuroplasticity.
It is essential to note that the management of concussion and its associated symptoms should be individualized and based on the latest evidence-based guidelines [ 1 ]. Healthcare providers should be aware of the potential for long-term complications and take a proactive approach to preventing and managing these complications [ 1 ].
From the Research
Causes of Spinning Sensations with Movements in Concussion Patients
- Spinning sensations with movements in patients with concussion can be attributed to various factors, including vestibular disorders, central vestibular dysfunction, and peripheral vestibular dysfunction 2.
- The differential diagnosis of post-concussive dizziness can be divided into non-vestibular, central vestibular, and peripheral vestibular causes, with many patients exhibiting both central and peripheral findings on vestibular testing 2.
- Specific diagnoses that can cause spinning sensations with movements in concussion patients include:
- Central vestibular disorders
- Benign Paroxysmal Positional Vertigo (BPPV)
- Labyrinthine dehiscence/perilymph fistula syndrome
- Labyrinthine concussion
- Secondary endolymphatic hydrops
- Temporal bone fracture
- Malingering (particularly when litigation is pending) 2
Role of Vestibular Rehabilitation in Managing Spinning Sensations
- Vestibular rehabilitation has been shown to be effective in reducing dizziness and improving gait and balance function after concussion 3, 4.
- A systematic review of randomized controlled trials found that vestibular rehabilitation can reduce symptoms in patients with concussion, including dizziness and balance disorders 4.
- Vestibular rehabilitation may be beneficial for both children and adults, with improvements observed in self-report, gait, and balance performance measures 3.
Importance of Identifying Underlying Symptom Generators
- Management of concussion and persistent post-concussive symptoms relies on identifying underlying symptom generators 5.
- Treatment options, including vestibular therapy, vision therapy, cognitive rehabilitation, and pharmacological management, can be tailored to address specific symptom generators 5.
- Accurate diagnosis and identification of underlying symptom generators are crucial for effective management of spinning sensations with movements in concussion patients 2, 6.