Clinical observations on vertigo within one month after head injury

Abstract

A study was made of 173 patients admitted to the hospital immediately after head injury.
1. Fifty-three (30%) complained of vertigo. Of the 44 patients under 9 years of age less than 14%. complained of vertigo.
2. The incidence of vertigo depended on the site of the lesion. It occured in 50% of those with occipital injuries, in 40% of those with blows to the temple, and in 20% of those with injuries of the face or forehead.
3. Skull fractures were found in 49 patients, and nearly 29% of them complained of vertigo, although vertigo itself is not necessarily associated with skull fracture.
4. Vertigo developed almost immediately after the injury in 19 cases, in 21 within 3 days, in 7 after a week and in 6 in 2-4 weeks.
5. Symptoms disappeared in 23 cases within 1 week, 16 within 2-4 weeks and 8 within 1-3 months, but in 2 cases vertigo persisted for 6 months.
6. Sixteen patients with head injuries and vertigo were seen only by neurologists.
7. Spontaneous nystagmus was seen in 10% of the cases and gaze nystagmus in 33%. Positional nystagmus was seen in 84% and positioning nystagmus in 86%.
8. Hearing impairment was found in 33% and an abnormal caloric test in 44%.
9. Eye tracking test and optokinetic nystagmus were abnormal in 37%. These results suggest that the positional nystagmus test is most useful in quickly detecting abnormalities in patients with vertigo after head injuries, though the site of the lesion can be determined by positional nystagmus tests only. In addition this test can rule out vertigo of psychosomatic origin or malingering.