Evidence of central and peripheral vestibular pathology in blast-related traumatic brain injury

Otol Neurotol. 2011 Jun;32(4):571-80. doi: 10.1097/MAO.0b013e318210b8fa.


Objective: To prospectively assay the vestibular and oculomotor systems of blast-exposed service members with traumatic brain injury (TBI).

Study design: Prospective, nonblinded, nonrandomized descriptive study.

Setting: Tertiary care facility (Department of Defense Medical Center).

Patients: Twenty-four service members recovering from blast-related TBI sustained in Iraq or Afghanistan.

Interventions: Focused history and physical, videonystagmography (VNG), rotational chair, cervical vestibular-evoked myogenic potentials, computerized dynamic posturography, and self-report measures.

Results: Vestibular testing confirms a greater incidence of vestibular and oculomotor dysfunction in symptomatic (vestibular-like dizziness) personnel with blast-related TBI relative to asymptomatic group members. VNG in the symptomatic group revealed abnormal nystagmus or oculomotor findings in 6 of 12 subjects tested. Similarly, rotational chair testing in this group revealed evidence of both peripheral (4/12) and central (2/12) vestibular pathology. By contrast, the asymptomatic group revealed less vestibular impairment with 1 of 10 rotational chair abnormalities. The asymptomatic group was further characterized by fewer aberrant nystagmus findings (4/12 abnormal VNGs). Computerized dynamic posturography testing revealed no significant differences between groups. Self-report measures demonstrated differences between groups.

Conclusion: Vestibular function testing confirms a greater incidence of peripheral vestibular hypofunction in dizzy service members with blast-related TBI relative to those who are asymptomatic. Additionally, oculomotor abnormalities and/or nystagmus consistent with central involvement were present in 10 of the 24 study participants tested. The precise cause of these findings remains unknown.

MeSH terms

  • Adult
  • Blast Injuries / physiopathology*
  • Brain Injuries / physiopathology*
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Middle Aged
  • Military Personnel
  • Oculomotor Nerve / physiopathology
  • Oculomotor Nerve Injuries*
  • Prospective Studies
  • Reflex, Vestibulo-Ocular / physiology*
  • Vestibular Function Tests
  • Vestibular Nerve / injuries*
  • Vestibular Nerve / physiopathology
  • Vestibule, Labyrinth / physiopathology