Cervicogenic Dizziness
Complaints of dizziness are among the most common reasons for a visit to the physician. Often these patients are cleared of serious pathology but not definitively diagnosed or treated. Often the presentation is not one indicative of true vestibular vertigo and the canalith repositioning maneuvers are ineffective. It is helpful for the practitioner to be familiar with other tests to indicate where the symptoms are coming from. The diagnosis of cervicogenic dizziness is generated by exclusion; dizziness that does not result from the vestibular system, central nervous system, vascular deficits or side effects of medication. There are currently no definitive tests with strong specificity for this condition. As such, ruling out other causes and using those tests which are provocative becomes important in the diagnosis and management of the condition.
Neck pain and/or loss of range of motion is an important factor in the inclusion criteria. But this doesn’t necessarily indicate causation. Cervical dysfunction which causes dizziness can cause the increase in neck muscle tone and stimulation of proprioceptors within the soft tissues of the upper cervical spine.
Try using these tests to identify dysfunction related to the cervical spine. Please note that these tests do not diagnose a cervicogenic problem but rather form an objective basis through which problems can be identified that are related to the dizziness.
Cervical Spine Range of Motion
Asses the quality and quantity of range actively. Note the onset of cervical pain. Use slow movement (<1Hz) to reduce stimulation of the vestibular system. If there is no loss of range or stimulation of pain or discomfort, it is less likely that cervicogenic dizziness is a cause.
Smooth Pursuit
The patient is asked to accurately and smoothly follow a slow-moving target side to side with his/her eyes, while keeping the head still. Quick saccadic eye movements to catch up to the target rather than smooth eye movement during midrange eye movement is an indication of impairment in the task. Reproduction of dizziness and blurred vision may also occur. If there is a cervical afferent component, the saccades will increase with 45° torso rotation under a fixed torso. If there is a positive test in neutral but no worse in rotation, the CNS is implicated.1 If this is the case; administer other CNS stressing tests such as the head thrust and a cranial nerve exam.
Gaze Stability
The patient is asked to focus their eyes on a point directly in front of them while they move the head into rotation and flexion and extension. Patients with neck pain often are unable to keep focus or move the head as far or as quickly, smoothly or without side flexion as asymptomatic individuals. Reproduction of dizziness and/or blurred vision may occur. This is similar to the dynamic visual acuity test used for those with vestibular disorders; however, in this test head movement is performed actively and slowly rather than passively and quickly. This approach is better suited to cervical related gaze disorders, as the cervical afferents are stimulated at lower movement frequencies compared to fast movements that stimulate the vestibular afferents.1
Head-Eye Coordination
The patient ï¬rst moves the eyes to a point of focus and then, while maintaining focus, moves the head to that point. This can be performed to the left and right, and up and down. Asymptomatic individuals are able to perform isolated eye and head movements and maintain focus. Often, patients with neck pain are unable to keep their head still while their eyes move or lose focus during the head movements.1
References:
1.Kristjansson E, Treleaven J. Sensorimotor Function and Dizziness in Neck Pain: Implications for Assessment and Management. J Ortho & Sports Phys Ther.2009;39(5);364-77.
2.Wrisley D, Sparto P, Whitney S, Furman J. Cervicogenic Dizziness: A review of diagnosis and treatment. J Ortho & Sports Phys Ther. 2000;30(12);755-66.