Cervico-ocular reflex upregulation in dizzy patients with asymmetric neck pathology

The aim of this study was to investigate whether the restriction in neck rotation and increased neck muscle tension could be causally related to vertigo and dizziness.

Seventy-one patients reporting vertigo and/or imbalance were divided into 2 groups: 45 subjects with unilateral restriction (R+) and 26 without restriction (R-) of cervical rotation and muscle tension in the clinical flexion-rotation test. The normal caloric test was the inclusion criterion. The control group comprised 36 healthy volunteers with no history of vertigo. The vestibulo-ocular reflex (VOR) and the cervico-occular reflex (COR) were measured through the videonystagmography (VNG) sinusoidal pendular kinetic test in the conditions of not inactivated head and immobilized head, respectively. The VNG-head torsion test (VNG-HTT) nystagmus was recorded.

Among the reported complaints, neck stiffness, headaches and blurred vision were more frequent in the R+ group than in both the R- group and the control group. VNG revealed an increased COR gain and the presence of VNG-HTT nystagmus in the R+ group only. Similarly, only in the R+ group a positive relationship between COR and VOR was observed.

Patients with asymmetric restriction in neck rotation and increased neck muscle tension reveal the tendency to have an increased response of the vestibular system, along with co-existing COR upregulation. Further research is needed to investigate the relationships between the activation of cervical mechanoreceptors and dizziness pathomechanisms. Int J Occup Med Environ Health. 2019;32(5):723-33.