Post-traumatic vertigo in children: a diagnostic approach.

The relatively high incidence of persistent post-traumatic headache and vertigo in children and adolescents presents a diagnostic and therapeutic challenge. It is often difficult to differentiate between functional complaints generated by psychological trauma or compensation-seeking and symptoms reflecting an organic etiology. The clinical and laboratory findings of 22 patients with post-traumatic headaches and vertigo were delineated into five major diagnostic categories: labyrinthine concussion, whiplash syndrome, basilar artery migraine, vertiginous seizures, and a non-specific post-traumatic dizziness. Patients with post-traumatic hearing loss were excluded from this study because they represent a group with different diagnostic problems and more recognizable organic pathology. Each patient had a complete neurologic evaluation including specific clinical vestibular tests (i.e., stepping test, reinforced Romberg, past-pointing evaluation, and positional tests using the Nylen-Hallpike maneuver. Laboratory studies included skull x-ray, computed tomography, electroencephalography, electronystagmography, and audiologic assessment. Symptoms, signs, and tests were evaluated in each category of post-traumatic vertigo to help establish the diagnosis and initiate treatment.