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Post Traumatic Vertigo or Dizziness | Guy S. DiMartino DC, JD, PA

Guy DiMartino June 6, 2013

This is the typical story. You are involved in a rear-end crash and you are told that you have a whiplash. Within a day or two, you start to feel out of sorts. You may explain it as lightheaded or dizziness. One day you roll over in bed or get out of bed quickly and the room starts to spin out of control. You may feel a little nauseous. These symptoms come and go. Youve gotten pretty dizzy turning your neck to back up your car or getting out of bed, but clearly the worst time you have is rolling over in bed. The other day, you never thought the room would stop spinning.

You go to the doctor and your told that it will be better in time. Your doctor may use the term, dizziness or vertigo. She may put on a medication called Antivert for a while but nothing really corrects the condition.

What is Vertigo?

In order to understand what vertigo is, we have to step back a minute and define dizziness. Generally, dizziness is the broad category of losing a sense of balance or feeling out of sorts. There are three categories of dizziness and vertigo is one of them.

Vertigo is the feel that either you or your surrounds are spinning. Think of the tilt-a-whirl amusement ride. Syncope is a big name for fainting or a brief loss of consciousness. The third category is non-syncopal and non-vertigo dizziness. These folks will usually describe not being able to keep balance or they feel out of sorts. Dizziness can be caused by a bunch of different things, however, when we are talking about whiplash, we can see a few common mechanisms.

3 Main Causes of Vertigo After Car Accident

Benign paroxysmal positional vertigo: The cochlea system or semi-circular canals in the ear can cause feelings of vertigo when changing position, like getting up quickly from a laying position or turning over in bed. The semi-circular canals contain a fluid called endolymph. Sometimes crystals can form in the fluid, and some healthcare providers believe that the forceful whipping of the head in a whiplash injury can loosen the crystals and allow them to float around the canal.

For many people, this condition can be corrected or at least controlled with specific physical therapy activities called Brandt-Daroff exercises and the Epley maneuver. Both can be performed at home.

Vertebro-basilar insufficiency: The area we look to this type of problem is at the base of the skull. The posterior brain and cerebellum, which is responsible for balance, gets its blood supply from the vertebral arteries, which travel up through the vertebrae and then make a pretty drastic turn at the base of the top of the spine and course up the foramen magnum (hole at the base of your skull). Probably the most notorious problem is called vertebral artery dissection, which can cause a disruption in blood supply to the PICA or posterior inferior cerebellar artery, that supplies a large portion of the cerebellum.

The thing to remember is that this area at the top of your neck (C1-C2) and the base of your skull (occiput) has a bunch of muscles and moving parts that can be injured with forceful flexion and extension of the neck that happens with a whiplash injury.

Cervicogenic Vertigo: Insurance companies and their doctors hate this condition and argue that it doesnt exist. I treated patients involved in car accidents for 17 years and empirically it does exist and I diagnosed and treated the condition in my practice. The condition makes sense neurologically and vascularly but insurance companies dont want to acknowledge the problem because of the prevalence of whiplash injuries.

If we were to define cervicogenic vertigo, it would be the person who complains of dizziness or spinning when they turn their neck. If there is some ligament laxity in the upper cervical spine, with rotation of the neck, there can be some brief compromise to the vertebral artery, which can cause transient vertigo.

The afferent or sensory nerves from the neck can also cause dizziness. So if there is muscle spasms and inflammation in the area, the nerves can be irritated. Disc injury in the neck or spinal cord bruising or compression can also cause dizziness for a number of reasons that are outside of this post but have to do with cranial nerve nuclei and nerve bundles in the head and neck.

Many times, if the clients treating physicians are able to diagnose the offending tissue or tissue that is damaged, treatment of the issue will also cause lessening or correction of the dizziness.

The Lesson Learned

The lesson to be learned here is that if you are injured in an accident and you start to experience dizziness dont let the insurance adjuster (who is not a doctor) or the insurance company doctor (who is an interested party) tell you that the accident didnt cause your dizziness.

The anatomy, physiology and anatomy of the neck and brain supports your contention but it will have to taught to a jury in plain language so they understand why youre experiencing these issues.