The Barany Society position on 'Cervical Dizziness'

Seemungal, Barry M.; Agrawal, Yuri; Bisdorff, Alexander; Bronstein, Adolfo; Cullen, Kathleen E.; Goadsby, Peter J.; Lempert, Thomas; Kothari, Sudhir; Lim, Phang Boon; Magnusson, Mans; Marcus, Hani J.; Strupp, Michael und Whitney, Susan L. (2022): The Barany Society position on 'Cervical Dizziness'. In: Journal of Vestibular Research - Equilibrium & Orientation, Bd. 32, Nr. 6: S. 487-499

Abstract

This paper describes the Barany Society Classification OverSight Committee (COSC) position on Cervical Dizziness, sometimes referred to as CervicalVertigo. This involved an initial reviewby a group of experts across a broad range of fields, and then subsequent review by the Barany Society COSC. Based upon the so far published literature, the Barany Society COSC takes the viewthat the evidence supporting a mechanistic link between an illusory sensation of self-motion (i.e. vertigo - spinning or otherwise) and neck pathology and/or symptoms of neck pain - either by affecting the cervical vertebrae, soft tissue structures or cervical nerve roots - is lacking. When a combined head and neck movement triggers an illusory sensation of spinning, there is either an underlying common vestibular condition such as migraine or BPPV or less commonly a central vestibular condition including, when acute in onset, dangerous conditions (e.g. a dissection of the vertebral artery with posterior circulation stroke and, exceedingly rarely, a vertebral artery compression syndrome). The Committee notes, that migraine, including vestibular migraine, is by far, the commonest cause for the combination of neck pain and vestibular symptoms. The committee also notes that since head movement aggravates symptoms in almost any vestibular condition, the common finding of increased neck muscle tension in vestibular patients, may be linked as both cause and effect, to reduced head movements. Additionally, there are theoretical mechanisms, which have not been explored, whereby cervical pain may promote vaso-vagal, cardio-inhibitory reflexes and hence by presyncopal mechanisms, elicit transient disorientation and/or imbalance. The committee accepts that further research is required to answer the question as to whether those rare cases in which neck muscle spasm is associated with a vague sense of spatial disorientation and/or imbalance, is indeed linked to impaired neck proprioception. Future studies should ideally be placebo controlled and double-blinded where possible, with strict inclusion and exclusion criteria that aim for high specificity at the cost of sensitivity. To facilitate further studies in cervical dizziness/vertigo, we provide a narrative view of the important confounds investigators should consider when designing controlled mechanistic and therapeutic studies. Hence, currently, the cervical COSC refrains from proposing any preliminary diagnostic criteria for clinical use outside a research study. This position may change as new research evidence is provided.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0957-4271
• Sprache: Englisch