Post-Traumatic Dizziness: Clinical and Medicolegal Aspects

Subjective complaints of dizziness after mild-to-moderate traumatic brain injury are common. Alterations in the mode of injury have changed the presentation symptoms. Evolutions in neuroimaging challenge conventional concepts regarding lack of evidence of injury following mild head trauma and provide hope for elucidating the site of lesion in patients with post-traumatic balance symptoms. Yet the vestibular clinician must maintain a healthy level of suspicion regarding potential exaggeration of symptoms and disability in patients with a financial incentive. Unique conditions warrant particular attention by the vestibular clinician, including chronic traumatic encephalopathy, catastrophization, and persistent postural and perceptual dizziness. The clinical significance of abnormalities, particularly on vestibular-evoked myogenic potential testing, needs to be better defined prior to their widespread application in the medical legal arena. The role of the medical expert is to provide opinion on matters requiring special knowledge to assist the court in reaching its findings. As such, this chapter provides an update on recent advances to consider in patients with dizziness after trauma.