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Cervical Intervertebral Disc Herniation with Cervicogenic Dizziness



Parallel abstracts

Cervicogenic dizziness is defined as "a non-specific sensation of altered orientation in space and disequilibrium originating from abnormal afferent activity from neck". A 54-yearold woman presented with frequent episodic dizziness related to head flexion in the last six months. Physical examination showed subjective imbalance and nuchal pain and numbness with neck flexion; there was, however, no Lhermitte's sign or Brudzinski's sign. Results of vestibular function test, pure tone audiometry, electrocardiogram, electronystagmogram, cervical vestibularevoked myogenic potential, blood tests, cervical spinal X-ray, and neck duplex ultrasonography all appeared non-contributory. While similarly unremarkable, brain magnetic resonance imaging/ angiogram did demonstrate herniation of C3-6 intervertebral discs. Wearing a rigid neck collar to immobilize the neck resulted in the disappearance of the symptom in the following week, and the patient, continuing to use the prescribed neck collar, no longer experience the dizziness symptom during the next six-month follow-up period. Various neck structures are involved in balance control (cervical afferents of musculatures), vascular tone control (carotid sinuses), blood circulation (carotid and vertebral arteries), and support and protection of the spinal cord (cervical vertebra); anomaly in any of these neck structures would contribute to cervicogenic dizziness. So far, there has been no specific test capable of expediting the diagnosis of cervicogenic dizziness; physicians should accordingly make it a priority to exclude any major pathologic lesions of the neck that may contribute to the symptom of dizziness.


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