Patients with cervical vertigo experience their symptoms when the neck is turned in one or more directions. Three causes may come into play in this syndrome: impaired vertebral artery circulation, cervical osteoarthritis, and whiplash injury. When the vertigo is experienced on neck torsion, there may be mild nystagmus. Consistent ENG findings have not been precisely described in the literature, although head-turning may elicit measurable nystagmus. The pathophysiology for this type of vertigo is not absolutely certain, but it is likely due to impairment of circulation to the vestibular centers by way of vertebral artery compromise.
Affected patients often give a typical history. The vertigo occurs only on turning the head, usually in just one direction, regardless of overall body position. When whiplash injury (typically from vehicular accidents with severe neck flexion and extension) is the cause, the vertigo is worse when turning the head to the more painful side. Here, the symptoms slowly subside after a few months if there is no permanent cervical spine injury. Very prolonged cases of whiplash vertigo may mysteriously improve after successful litigation.
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