Evaluation of Balance Disorders After Minor Head and Whiplash Injuries.

T he increased use of automobile transportation and lack of awareness of safety measures at work have resulted in many accidents, which have caused head and neck injuries. Direct blow to the head may result in minor brain injury, such as postconcussion syndrome. Flexion-extension or whiplash injury is a very common sequel of indirect trauma to the neck. Many patients suffering from these syndromes complain of dizziness and disorders of equilibrium. The vestibular symptoms of postconcussion syndrome may be due to brain concussion in regions involved in maintaining balance or to concussion of the labyrinth. However, the etiology of vertigo after whiplash injury is less well understood, and several major theories have been proposed: (1) cervical sympathetic irritation, (2) abnormal neck reflex, (3) vertebrobasilar artery insufficiency, and (4) cerebral or labyrinthine concussion. In fact, some have suggested that balance impairments often are attributed to psychological or emotional problems [1]. The most common test of the vestibular system is electronystagmography (ENG). This test assesses the response of the horizontal semicircular canal as manifested by the vestibuloocular reflex. Posturography, on the other hand, is considered as a test of the functional integrity of the sensory input of the three systems involved in maintaining balance (i.e., the visual, the somatosensory , and the vestibular systems). This test can validate ENG findings. In addition, it can detect vestibular malfunction that cannot be detected by conventional ENG (e.g. , pathology involving the vertical semicircular canal, otolithic organs, central vestibular