Imperial College London
Alternate

Dr Qadeer Arshad

Faculty of Medicine, Faculty of Medicine Centre

Honorary Clinical Senior Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 5527q.arshad

 
 
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Location

 

Lab BlockCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Calzolari:2021:brain/awaa386,
author = {Calzolari, E and Chepisheva, M and Smith, RM and Mahmud, M and Hellyer, PJ and Tahtis, V and Arshad, Q and Jolly, A and Wilson, M and Rust, H and Sharp, DJ and Seemungal, BM},
doi = {brain/awaa386},
journal = {Brain},
pages = {128--143},
title = {Vestibular agnosia in traumatic brain injury and its link to imbalance.},
url = {http://dx.doi.org/10.1093/brain/awaa386},
volume = {144},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understood feature in patients with TBI. Damage to the inner ear, nerve, brainstem, cerebellum and cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment-from reflex to perception-is required. In a previous report, postural instability was the commonest neurological feature in ambulating acute patients with TBI. During ward assessment, we also frequently observe a loss of vertigo sensation in patients with acute TBI, common inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, suggesting a 'vestibular agnosia'. Patients with vestibular agnosia were also more unbalanced; however, the link between vestibular agnosia and imbalance was confounded by the presence of inner ear conditions. We investigated the brain mechanisms of imbalance in acute TBI, its link with vestibular agnosia, and potential clinical impact, by prospective laboratory assessment of vestibular function, from reflex to perception, in patients with preserved peripheral vestibular function. Assessment included: vestibular reflex function, vestibular perception by participants' report of their passive yaw rotations in the dark, objective balance via posturography, subjective symptoms via questionnaires, and structural neuroimaging. We prospectively screened 918 acute admissions, assessed 146 and recruited 37. Compared to 37 matched controls, patients showed elevated vestibular-perceptual thresholds (patients 12.92°/s versus 3.87°/s) but normal vestibular-ocular reflex thresholds (patients 2.52°/s versus 1.78°/s). Patients with elevated vestibular-perceptual thresholds [3 standard deviations (SD) above controls' average], were designated as having vestibular agnosia, and displayed worse posturography than non-vestibular-agnosia patients, despite no difference in vestibular symptom scores. Only in patients with impaired postural control (3 SD above c
AU  - Calzolari,E
AU  - Chepisheva,M
AU  - Smith,RM
AU  - Mahmud,M
AU  - Hellyer,PJ
AU  - Tahtis,V
AU  - Arshad,Q
AU  - Jolly,A
AU  - Wilson,M
AU  - Rust,H
AU  - Sharp,DJ
AU  - Seemungal,BM
DO  - brain/awaa386
EP  - 143
PY  - 2021///
SP  - 128
TI  - Vestibular agnosia in traumatic brain injury and its link to imbalance.
T2  - Brain
UR  - http://dx.doi.org/10.1093/brain/awaa386
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33367536
UR  - http://hdl.handle.net/10044/1/83858
VL  - 144
ER  -
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