few months ago, Samuel and I had a conversation about the existence of cervical vertigo through Facebook. I must admit that I was surprised that there was so much controversy.
From here I want to thank Samuel to get closer to that vision and to sow doubt. Querying is always interesting ideas and everyday life.
To avoid confirmation bias, I tried to find information denied cervical vertigo, but I must say that I'm better at gathering information that supports it.
The closest are some neurologists to admit ENT and dizziness related to neck in some of their rankings are derived from vertebrobasilar alterations, and this more than cervical, understood as a problem vascular.
consider other causes in these classifications, which is vertigo related to migraine. Some authors consider that many patients diagnosed with migraine headaches are actually misdiagnosed cervicogenic, because they share both clinical entities. And some authors such as Dean Watson, suggest that migraine-related vertigo of these classifications, could also pose a cervical origin.
I think the reason for the controversy of vertigo cervicogenic are several reasons:
The 1 st is the historical evolution of the classification vertigo. It was not until the 1950 when introduced the diagnosis of cervical vertigo. Research on cervical origin is not as publications such as the vestibular, and many are of good quality.
The # 2 is that the diagnosis of cervicogenic vertigo is made by elimination of vestibular involvement. Some are questioning the cervical origin, and for many what is questioned is the same frequency, which is to suggest that overdiagnosis. However, medical studies on the incidence of cervicogenic vertigo is very rare, which is to say that diagnostic little.
The 3 rd is the relation of dizziness to the cervical spine: the absence of a mechanism convincing Dizziness cervicogenic tends to be a controversial diagnosis, because there is no evidence to confirm what the cause of dizziness, but this is no more true than in others well accepted.
(This article argues that the cervical proprioceptors are of secondary importance compared to the buccal cervical nystagmus that is to be demonstrated and that the incidence of cervical dizziness is small).
" neck afferents not only help in the coordination of eye, head and body, but also affect spatial orientation and postural control. This implies that stimulation or lesions in these structures can cause cervical vertigo. In fact, local anesthesia unilateral upper cervical dorsal roots induces ataxia and nystagmus in animals, and ataxia without nystagmus in humans. If cervical vertigo exists outside of these experimental conditions, it is clear that is characterized by ataxia and gait instability, and not by a clear sense of rotational or linear vertigo. The neurological, vestibular, and psychosomatic must first be ruled out before attributing the feeling of dizziness and unsteadiness cervical origin. To date, however, the syndrome is still only a theoretical possibility pending a reliable clinical test to demonstrate its independent existence. " Brandt 1996
Definition
"Beverly nonspecific altered orientation in space and imbalance from an abnormality in the afferent activity of the neck (Furman and Cass)
Clinical
Feeling of instability / disequilibrium. For some authors, the spinning objects, typical of vertigo, is not very common, so that suggests it's more accurate to speak of cervicogenic dizziness rather than vertigo. There are many types of vertigo: target (when moving in the environment) subjective (when moving is the subject), oscillopsia (when objects are moved back and forth) may refer feeling that they will fall or going on a boat ... but the truth is to know exactly the feeling does not explain much about its origin, so until date this information has not proven to be very relevant. Nevertheless, in various classifications are differentiated on the type of feeling as to the origin.
De-minute hour, which increases with neck pain and cervical movements and decreases local cervical treatment. There may be nausea, blurred vision, restricted cervical mobility, difficulty walking in the dark, climbing stairs or through the door frame without collision. Associated with flexion-extension injury (whiplash), headaches, and nystagmus. (Although some doubts it, several studies confirm this).
Classically neck pain was felt that should be present in cervical dizziness. The presence of neck pain dizziness not necessarily imply that the dizziness was cervical, but this was not discarded. Recent studies show that the dizziness of cervical origin may present strategy in the absence of neck pain are the results based on different tests:
cervical EPA (joint position error)
postural stability
Control of eye movements
Diagnosis
Ryan and Cope were the ones who introduced the concept of cervical vertigo in 1955. They published 3 cases of patients with dizziness that they attributed to cervical spondylosis. The 3 patients improved their neck pain and dizziness with the injection of an anesthetic in the posterior neck muscles.
Brown says the relationship between the neck and balance 150 years has been studied in animals. It highlighted the connection between cervical dorsal roots and the core vestibular receptors in the neck (proprioceptors and joint receptors) play an important role in eye-hand coordination, perception of balance and postural adjustments.
Cohen described disorders of balance, orientation and coordination in primates that had been injected an anesthetic into the dorsal roots of the first three dorsal roots.
The same experiments by Biemond and de Jong in rabbits, cats and primates produced nystagmus and ataxia.
test have claimed to be diagnostic of cervical vertigo, such as sustained neck extension. In addition to having found little results, cervical extension represented a change in head position, therefore did not discriminate the vestibular origin.
maneuver body rotation with fixed head (Head-fixed, body-turner maneuver), or cervical nystagmus test by rotating the neck (Neck torsion nystagmus test) Test of differentiation or cervical-ear Maitland, overcome this problem, although the valuation of nystagmus in the test is controversial.
" The presence of nystagmus in the trunk rotation with the head fixed indicates cervical vertigo" (Hülse 1983).
Oostelveld In the study 64% of 262 patients with neck pain whiplash had nystagmus testing. However, 50% of subjects without cervical pathology also developed nystagmus with the test, so only proved to be a manifestation of the oculo-cervical reflex. Other studies also question the finding of nystagmus as a diagnosis.
Diagnostic evaluation of the cervical nystagmus in cervical torsion test (1993)
(A sample of 40 patients with cervical osteoarthritis , where 47% had nystagmus in cervical rotation test and 37% with Nylen's positional nystagmus).
posturography Some studies have shown that alteration of postural control in patients with suspected cervical origin was different from that obtained postural change in patients with vestibular neuritis and healthy individuals. But the means are not suitable as a diagnostic tool for clinical practice.
(This one suggests the posturography como herramienta diagnóstica del mareo cervical).
neck torsion test and smooth tracking (Smooth pursuit neck torsion test) and Rosenhall Tjell . Is considered specific to detect eye movement disorders due to impaired cervical afferent input. The patient should continue to look a laser beam moving horizontally at a speed of 20 º per second and this compares with the neck in neutral position with the neck rotated.
Studies in people with whiplash injury had a positive test, whereas in patients with vertigo of vestibular origin or central The test was negative, suggesting that the dizziness or vertigo associated with whiplash due to the alteration of the somatosensory cervical hyperextension injury.
Smooth pursuit neck torsion test: a specific test for cervical Dizziness. American Journal of Otology (Tjell 1998)
This test has shown a sensitivity of 90% and a specificity of 91%
This test has shown a sensitivity of 90% and a specificity of 91%
In this study, which can be read completely and English used a hammer with the rubber tip, a vibration platform for posturography test, electronystagmography, and a vibrating tool. Of a total of 2,304 patients presenting with vertigo, and who have made these tests, 9.8% showed that it was a dizzying cervical C1-C2 being the most frequently affected.
In the eighteenth century, a treatment for dizziness were the bloodletting. All scientific community advocated bleeding, especially one of the most prestigious doctors in the United States who worked at the Court. A skeptical young doctor questioned the bleeding, but never heeded him. It was not until the nineteenth century where the studies found that bleeding in addition to killing people was not effective for the treatment of dizziness.
The knowledge we have is given by the historical moment live. So you see a very clear things is always good to keep a reasonable doubt, and above all not to be inflexible in the belief, or blunt in statements, as long as they speak in scientific terms.
Treatment
is not the purpose of this post to delve into the different treatments. Just present some studies that evaluate the efficacy of manual therapy of cervical cervicogenic vertigo.
A sample of only 22 patients with suspected cervical vertigo were found in neck pain and improvement with treatment.
Of 50 patients with dizziness, 31 were diagnosed with upper cervical dysfunction (14 in C1, 6 C2, 4 C3 and 7 at various levels) and 19 had no cervical dysfunction. The 50 were treated with cervical mobilization and manipulation. Of the 31 with cervical dysfunction noted improvement in 24 (77%) and 5 of them were completely fine. Of the 19 who had no cervical dysfunction, only 5 reported improvement (26%) and none of them quite right.
The authors of this review concluded that evidence is lacking on the effectiveness of manual therapy on cervicogenic dizziness and requires more studies. But shelling some studies report effectiveness between 73-82%
And finally, I leave the link one of the most interesting articles and you can read full
I hope you liked it ...
... I have dizzy with cervical
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