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

Int J Occup Med Environ Health. 2019 Oct 16;32(5):723-733. doi: 10.13075/ijomeh.1896.01428. Epub 2019 Oct 7.

Abstract

Objectives: 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.

Material and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: COR upregulation; afferents; cervical vertigo; dizziness; muscle tension; proprioception.

MeSH terms

  • Adult
  • Case-Control Studies
  • Dizziness / physiopathology*
  • Female
  • Headache
  • Humans
  • Male
  • Middle Aged
  • Muscle Tonus
  • Neck / physiopathology*
  • Neck Muscles / pathology
  • Reflex, Vestibulo-Ocular
  • Vertigo / physiopathology*
  • Vestibular Function Tests