What are the treatment options for a patient with dizziness and double vision after a head injury, possibly a concussion, with unknown medical history and demographics?

Immediate Management of Head Injury with Dizziness and Double Vision

You need emergency medical evaluation immediately—call 911 or go to the emergency department now, as the combination of dizziness and double vision after head trauma may indicate serious intracranial injury requiring urgent imaging and neurological assessment. 1, 2

Why This Is an Emergency

Your symptoms represent red flags that require immediate evaluation:

• Double vision (diplopia) after head trauma can indicate cranial nerve injury, brainstem dysfunction, or increased intracranial pressure 1
• Dizziness combined with other neurological symptoms warrants urgent assessment to rule out intracranial bleeding, skull fracture, or brain edema 2
• These symptoms cannot be adequately evaluated without neuroimaging and comprehensive neurological examination 1

What Will Happen in the Emergency Department

Emergency providers will perform several critical assessments:

• Neurological examination to assess mental status, cranial nerve function (particularly eye movements), and focal deficits 1, 2
• CT imaging of the head to rule out intracranial hemorrhage (epidural hematoma, subdural hematoma), skull fracture, or brain swelling 1, 2
• Assessment for increased intracranial pressure through fundoscopic examination and clinical evaluation 1
• Determination of need for hospital admission based on imaging findings and clinical status 1, 2

Critical Pitfall to Avoid

Do not wait at home to see if symptoms improve—the combination of dizziness and double vision requires immediate evaluation, as delayed diagnosis of intracranial bleeding can be life-threatening. 2

If Imaging Rules Out Serious Structural Injury

If CT scan is negative for bleeding or fracture, you likely have a concussion with vestibular and oculomotor dysfunction:

• Complete cognitive and physical rest is required for the first 24-48 hours only 3
• Close follow-up within 24-48 hours with a healthcare provider trained in concussion management is mandatory 2
• Systematic evaluation for specific causes of your symptoms will be needed, including vestibular testing, oculomotor assessment, and cervical spine examination 3, 4

Understanding Your Symptoms

Both dizziness and double vision are common concussion symptoms that have identifiable causes:

• Double vision occurs in concussion due to oculomotor control deficits, which are present in 97.8% of athletes with post-concussive dizziness 4
• Dizziness after head trauma is multifactorial in 90% of cases, involving central vestibular dysfunction, peripheral vestibular injury, and cervical spine dysfunction 4, 5
• 88% of patients with post-traumatic dizziness show at least one audio-vestibular abnormality on testing, providing strong evidence for an organic basis 6

Active Treatment After Emergency Evaluation

Once serious injury is ruled out and you're cleared for treatment:

• Vestibular rehabilitation should begin if vestibular dysfunction is identified, including habituation exercises, adaptation exercises, and balance training at least once weekly for minimum 4 weeks 3
• Oculomotor vision treatment including vergence training, accommodative training, and eye movement exercises should be implemented for persistent double vision 3
• Sub-symptom threshold aerobic exercise with gradual increases should begin after the initial 24-48 hour rest period 3
• Avoid prolonged rest beyond 48 hours, as this may have negative implications for recovery 3

Expected Recovery Timeline

• Most concussion symptoms resolve within 7-10 days, though 15-20% of patients develop persistent symptoms beyond 3 months 2
• If symptoms persist at 2 weeks, active management can prevent progression to persistent post-concussion syndrome 3
• Systematic evaluation at 2 weeks should assess fatigue (17.2% prevalence) and forgetfulness (14.6% prevalence) 3

Again: Go to the emergency department immediately. Do not drive yourself—have someone take you or call 911. 2