cervicogenic dizziness

[dr_purvi]

hi there.... i need some material for a seminar on this topic... plz help

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[stephandriver]

Dear Purvi,

Cervicogenic dizziness is a big word meaning very little. Basically the assumption here is that instead of the otoliths and canals of the middle ear malfunctioning and causing dizziness the cause is coming from some pathology/condition of the Cx.

Apart from Cx based neural connections to the central balance mechanism of the brain, of which I do not know of any evidence base, I would direct you to research the vertebrobasilar artery. Remebering your basic anatomy of this artery in the tranverse foramen of the cervical vertebrae, any undue compromise of this artery by pathology arising from structures in the cervical spine will cause reduced bloodflow directly to the brain. Hence the dizziness. Therefore find causes of compromise for your presentation ie osteophytic formation, discal lesions, instability especially C1-2 (alar ligament and transverse ligament testing).

Include in your presentation then the differential diagnosis between patholgy arising from the structures of the middle ear and the structures of the Cx. ie rotating the head keeping the shoulders fixated, then rotating the shoulders keeping the head fixated.

Neurology has never been my strong point, especially considering that it can be specualtive. But I am sure that if there exists central stenosis of the Cx then it is entirely possible that by performing sustained quadrant manouvres/Cx rotation and in doing so compromising the spinal cord this could cause some sort of reflex dizziness. Good luck researching this one though!

Finally in your presentation dont forget to cover the anatomy of the vertebrobasilar artery. Especially as it winds around the passage from the tranverse foramen at C1 then the occipital condyles and into the foramen magnum. Very tight and snaky little passage indeed. Mention how vulnerable it is at this site. The use of an articulated skeleton at this point would be very instructive to the class.

Hope this at least helps!

Cheers
Scooba.

[dr_purvi]

thanks so much for ur help....

[Fyzzio]

Have a look at this:

D.M. Wrisley et al
Cervicogenic dizziness: A review of diagnosis and treatment
J Orthop Sports Phys Ther - Volume 30 - Number 12 - December 2000

regards,
Fyzzio

[physiokavi]

cn anyone pls help me on this , as i have a female pt'of age 35 with dizziness nd nausea as her symptom on doing daily activities and moving from bed or doing any fast activity. her brain MRI , x-ray (xcept revealing cervical rib) , and audiometry reports are normal and VBI tests are also normal . she has cervical ROM full but upper traz and its occipital origin taut + tenderness in all cervical spines . this is the picture from last 3 months .she gives hitory of numbness in both upper xtremity till mid-forearm a month back.what treament cn b best for her.

[IceMan]

Sounds like a possible cord compression.

Could you reproduce/exacerbate the bilateral UE numbness with ROM and/or segmental testing of the cervical spine? How about reflexes, muscle strength of the UE's? Thoracic spine, ribs (1st rib in particular)?

Give us some more details...

[smshaffe]

Despite most people's lack of familiarity with it, there is a bunch of research on cervicogenic dizziness CD. There is, however, more research on why it occurs than how to treat it.

Cervicogenic dizziness was first reported in 1955 by Ryan and Cope under the term ‘cervical vertigo.’ Experimentally induced cervicogenic dizziness was later elicited via anesthetic injection in the necks of normal subjects (de Jong 1977), further proving the neck to be one of the possible sources of dizziness. More specifically, mechanoreceptors of the neck have been implicated as a contributing cause of disequilibrium (Wyke 1979). It has also been shown that proprioceptive input originating in the neck helps in coordination of the eyes and head and also plays a role in spatial awareness (Brandt and Bronstein 2001). This is of particular importance as it helps explain the link between peripheral somatosensory structures and the perception of equilibrium.

It is known that whiplash (Wrisley 2000, Endo et al. 2006), cervical spondylosis (Reid and Rivett 2008), hypomobility (Reid and Rivett 2008), hypermobility (Malmström et al.2007), and poor dynamic and postural control (Heikkilä and Wenngren 1998, Malmström 2007) can all contribute to CD. Impairment based musculoskeletal treatment (Malmström 2007), combined manual treatment, exercise, modalities, and medication (Bracher et al. 2000), and SNAGS (Reid and Rivett 2008) have all been shown to successfully treat CD.

Here are some of the better studies encase you are interested.

Reid SA, Rivett DA. Manual therapy treatment for cervicogenic dizziness: a systemic review. Manual Therapy. 2005;10:4-13.

Malmström EM, Karlberg M, Melander A, Magnusson M, Moritz U. Cervicogenic dizziness – musculoskeletal findings before and after treatment and long-term outcome. Disability and Rehabilitation. 2007;29:1193-1205.

Borg-Stein J, Rauch SD, Krabak B. Evaluation and management of cervicogenic dizziness. Critical reviews in physical and rehabilitation medicine. 2001;13:255-263.

Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic Dizziness: A Review of Diagnosis and Treatment. Journal of Orthopaedic & Sports Physical Therapy. 2000;30:755-766.

Reid SA, Rivett DA, Katekar MG, Callister R. Sustained natural apophyseal glides (SNAGs) are an effective treatment for cervicogenic dizziness. Manual Therapy. 2008;13:357-366.

Bracher ES, Almeida CI, Almeida RR, Duprat AC, Bracher CB. A combined approach for the treatment of cervical vertigo. Journal of Manipulative and Physiological Therapeutics. 2000;23:96-100.

Revel M, Andre-Deshays C, Minguet M. Cervicocephalic Kinesthetic Sensibility in Patients with Cervical Pain. Archives of Physical Medicine and Rehabilitation. 1991;72:288-291.

Revel M, Minguet M, Gergoy P, Vaillant J, Manuel JL. Changes in Cervicocephalic Kinesthesia After a Proprioceptive Rehabilitation Program in Patients With Neck Pain: A Randomized Controlled Study. Archives of Physical Medicine and Rehabilitation. 1994;75:895-899.

[physiokavi]

no she does not have any sensory deficit , nd motor weakness. upperlimb tension tests are also negative . i gave her intermittent traction for 10 mins. , heat therapy, ROM exercies +chin tucks for deep flexor strenghtning ex., felt better but gets radiating pain on carrying heavy wts. , and doing household work , her symptoms of dizziness hs reduced. she is on medications also.

[Alessia]

Ciao!
Here are some other articles that i found of interest:
Mitchell J. Doppler insonation of vertebral artery blood flow changes
associated with cervical spine rotation: Implications for manual therapists.
Physiother Theory Pract. 2007 Nov-Dec;23(6):303-13

Bayrak IK, Durmus D, Bayrak AO, Diren B, Canturk F. Effect of cervical
spondylosis on vertebral arterial flow and its association with vertigo. Clin
Rheumatol. 2009 Jan;28(1):59-64

Karatas M. Central vertigo and dizziness: epidemiology, differential
diagnosis, and common causes. Neurologist. 2008 Nov;14(6):355-64

Endo K, Suzuki H, Yamamoto K.
Consciously postural sway and cervical vertigo after whiplash injury.
Spine. 2008 Jul 15;33(16):E539-42

Cheers

[thabiso]

Hi,

Try this article
Landel R. Dizziness: A Screening Examination and Differential Diagnosis Decision-Making Process for Physiotherapist. Physiotherapy Singapore 2002;5(3):46-50

The educata website must have something from him in more detail as well.

All the best

[sheri]

Hi, i have not read the presenting articles in the previous posts. i shall do so shortly though
not going to harp on about the various possible causes of the problem. what i do know from experience is that patients with neck pain with related dizziness/nausea/vertigo have ridiculously tight and tender anterior cervical musculature. these are very often ignored and physio head straight for the upper traps, lev scap etc etc. lie the patient in supine with the head rotated to the contralateral side and extended (if position does not reproduce dizziness) and just palpate SCM, scalenes etc. this palpation can often reproduce symptoms.
in addition to this dizziness is related to neural structures. i would try gentle neural mobilisation probably just passive neck flexion with/without an added slump (see butlers text).

good luck with your project!

[sheri]

found this excellent case study which assists in going about differentiating causes for dizziness. its online in pdf format:

http://jmmtonline.com/documents/v14n3/SchenkV14N3.pdf