Posttraumatic Vertigo

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Closed head injuries account for a significant percentage of patients with vertigo. Vertigo or gait unsteadiness is a common complaint following a head injury. Acute posttraumatic vertigo is caused by a direct injury to the labyrinthine membranes. Its onset is immediate following the head injury, and it produces constant vertigo, nausea, and vomiting. Such patients may have sustained a concomitant fracture of the temporal bone. Vertigo immediately associated with a closed head injury warrants computed tomography (CT) or magnetic resonance imaging (MRI) to rule out an extradural or intradural hematoma. Vertigo due to direct labyrinthine trauma tends to resolve within several weeks. Closed head trauma can also displace otoconia from the utricular maculae, precipitating an attack of BPPV. Some patients with a history of a closed head injury develop a postconcussive syndrome. Although true vertigo is uncommon with this disorder, gait unsteadiness or a vague sense of dizziness are quite common. Such patients should be referred to a neurosurgeon or neurologist for special imaging and neuropsychiatric testing.

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