Cervical vertigo
- aNeurologische Klinik, Klinik Groshadern, Ludwig Maximilians Universitat, Munchen, Germany, bDivision of Neuroscience and Psychological Medicine, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
- Dr AM Bronstein A.Bronstein{at}ion.ucl.ac.uk
- Received 2 October 2000
- Accepted 29 November 2000
Proprioceptive input from the neck participates in the coordination of eye, head, and body posture as well as spatial orientation. On this basis it has been argued that a syndrome of cervical vertigo might exist. However, cervical vertigo is a controversial clinical entity and patients with suspected disease often have alternative bases for their symptoms.1
The neck contains mechanisms directly involved in balance control (neck afferents), cardiovascular control (carotid bodies), and purely vascular structures (carotid and vertebral arteries). Neck movements are also invariably associated with head movements. Thus, experiencing unsteadiness or vertigo associated with neck movements could be due to a disorder in vestibular, visual, vascular, neurovascular, or cervicoproprioceptive mechanisms. Table 1 summarises the possible differential diagnoses.
- In this window
- In a new window
Differential diagnosis of cervical vertigo: vertigo, unsteadiness, or oscillopsia triggered/aggravated by head-neck movements
Without further specification, however, the term cervical vertigo is reserved for cases where the suspected mechanism is proprioceptive. The reasoning is as follows. The perception of head rotation is mediated by vestibular, proprioceptive, or visual receptors. Vertigo should therefore be induced by stimulation of any of these systems. Degenerative or traumatic changes of the spine could induce distorted sensations of head motion (vertigo). This line of thought is, however, not as straightforward as it seems. Clearly, vestibular lesions or experimental vestibular activation (for example, a caloric test) produce powerful illusions of self motion. Similarly, visually induced illusion of self motion is readily experienced—for example, the feeling that the train we are in has started to move off when, in fact, it is the train next to ours which has done so.
Evoking a clear sensation of head turning by cervical stimulation is, by contrast, not so straight forward. To start with, to investigate neck proprioception, the head must be immobilised while the trunk is rotated. Unless this technical precaution …
