ORIGINAL ARTICLES

CERVICAL VERTIGO

Les cervicalgies ainsi que le vertige et l’étourdissement constituent des motifs fréquents de consultation. Quand ces symptômes surviennent de façon concomitante chez le même patient, la relation de cause à effets est suggérée. Elle est en revanche difficile à prouver d’autant plus que l’étourdissement cervicogénique reste une entité controversée et peu connue par les praticiens qui, souvent, dissocient la douleur cervicale et le vertige rapportés par le patient. L’objectif de cette mise au point était de préciser la démarche diagnostique et thérapeutique du praticien devant un patient suspect de trouble de l’équilibre d’origine cervicale dont la principale plainte demeure une cervicalgie associée à un étourdissement. Les mécanismes physiopathologiques impliqués dans sa survenue ont été également détaillés.

Neck pain and dizziness are common symptoms. When these symptoms coexist, the causal relationship between them is suggested, but not obvious to prove, since cervicogenic dizziness remains a controversial entity and is poorly diagnosed. In some cases, vertigo can be dissociated from neck pain improperly. The purpose of this review was to clarify the practitioner's diagnostic and therapeutic approach in a patient suspected of having a balance disorder of cervical origin, whose main complaint remains neck pain associated with dizziness. It also details the pathophysiological mechanisms involved in its appearance.

Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.

Cervical vertigo (CV), one of the most common causes of vertigo, makes patients feel dizzy, which seriously affects patients’ lives. As a traditional Chinese bone-setting manipulation, Tuina is widely used to treat CV. This article aims to evaluate the effectiveness and safety of Tuina for CV.

Nine databases were searched. Methodological quality was evaluated with the Cochrane Collaboration's tool. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was applied to determine confidence in the effect estimates. Stata 12.0 software was used to carry out the meta-analysis, and a trial sequential analysis (TSA) was performed with TSA 0.9.

Nine randomized controlled trials (RCTs) were included. Low-quality evidence suggested that Tuina showed a significantly higher effectiveness rate compared to massage therapy (risk ratio (RR) = 1.11, 95% confidence intervals (CI): 1.05 to 1.17, p < 0.0001) and cervical traction (RR = 1.37, 95% CI: 1.09 to 1.72, p = 0.007; I² = 0%, p = 0.826). Two trials reported that Tuina was better than acupuncture (RR = 1.40, 95% CI: 1.07 to 1.83) or betahistine mesilate (RR = 1.17, 95% CI: 0.99 to 1.37) based on an improved effectiveness rate. Low-quality evidence showed that Tuina was superior to massage therapy in improving scores on the evaluation scale for cervical vertigo (ESCV) (weighted mean differences (WMD) = 2.52, 95% CI: 1.11 to 3.94, p < 0.0001). Adverse events were tolerable. TSA revealed that an improved effectiveness rate was indicated.

Tuina might improve the effectiveness rate and ESCV scores in patients with CV. However, the level of all the available evidence was low, and larger-scale and well-designed RCTs should be encouraged.

A new and unique treatment for cervical vertigo with botulinum toxin is presented for a woman who sustained neck trauma from being hit by a wave. A diagnosis of cervical vertigo and cervical dystonia was confirmed by history, physical exam, dystonia on EMG exam, and a negative test for benign paroxysmal positional vertigo.

She experienced consistent resolution of her vertigo symptoms and pain after each treatment for a total of 5 treatments with botulinum toxin to the upper cervical muscles. This report appears to be the first to demonstrate the missing link between vertigo and cervical dystonia with pain. Chemodenervation was effective in treating cervical vertigo and is likely to have altered the cervical proprioceptive input by relaxing the overactive muscles and/or by decompression of cervical nerves.