Dizziness in Cerebral Disorders

After the acute trauma (e.g., blunt head trauma, sports-related concussion = SRC), the patients should undergo a vestibular/ocular motor screening procedure to identify peripheral/central impairment (e.g., spontaneous/head-shake nystagmus, pathological HIT, gaze/smooth pursuit testing) and a possible overlap with MTBI/whiplash-associated disorder (= WAD; McKeithan et al. 2019; Kontos et al. 2017, Ekvall Hansson et al. 2006) as soon as possible. This is important to plan extended diagnostics (e.g., complete neuro-otological workup) (Basta et al. 2005, 2007) and therapy/rehabilitation. Special emphasis should be put on blast exposed patients (usually military personal) because they are most likely patients with subsequent MTBI/neuropsychiatric disorders (e.g., PTSD) and a delayed recovery (Akin et al. 2017; Denby et al. 2020). Neuroimaging is indicated with mor GCS severity and/or red flag clinical findings (MRI and/or HR-CT of the petrous bone) should reliably exclude central vestibular pathology and/or intracochlear hemorrhage/microfractures of the otic capsule, particularly in children (Ernst et al. 2005; Ellis et al. 2015; Clement 2019). One rare, but existing problem is the exacerbation of a hitherto unknown/clinically silent SCDS upon the head impact (Fig. 6.1).