ChiroACCESS Clinical Review



Dizziness of Cervical Origin: Diagnosis

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Lead Author(s): 

Dwain M. Daniel, D.C.

  

How this evidence was rated:

Strength of Recommendation Taxonomy (SORT)



Published on

August 2, 2007

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It is important for the physician to recognize vertigo/dizziness that may indicate a potentially life-threatening condition from a more benign condition. Although a discussion on vertigo in general is beyond the scope of this paper, an excellent review outlining proper steps to diagnosis can be found in an article by Labuguen in the American Family Physician (1).

A key component to the diagnosis of dizziness of cervical origin (DCO) is taking a complete history. Clinical testing has limited value except to rule out other conditions which is often the basis upon which the diagnosis of DCO is made. Much can be learned from the patient’s history, occasionally reducing the need for time-consuming and possibly expensive clinical testing.

The characteristics of DCO are (2):

1. Often associated with whiplash injury, severe cervical arthritis, herniated cervical disc or head trauma.
2. Often with concurrent neck pain, increased symptomology on neck movement, limited range of motion or headache.
3. Gradual onset after injury.
4. Episodic in nature lasting from minutes to hours.
5. Usually described as “light-headedness or dizziness,” not “the world is spinning around me.”

The most common type of dizziness is benign paroxysmal positional vertigo which accounts for 19% of all cases of dizziness (3). It is often diagnosed by using the Dix-Hallpike maneuver, a relatively easy to perform procedure, which is illustrated and described in detail by Labuguen in his article on vertigo (1).

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References

1. 

Labuguen RH. Initial evaluation of vertigo. Am Fam Physician 2006; 73(2):244-251.



2. 

Wrisley DM, Sparto PJ, Whitney SL, Furman JM. Cervicogenic dizziness: a review of diagnosis and treatment. J Orthop Sports Phys Ther 2000; 30(12):755-766.



3. 

Handa PR, Kuhn AM, Cunha F, Schaffleln R, Gananca FF. Quality of life in patients with benign paroxysmal positional vertigo and/or Meniere's disease. Rev Bras Otorrinolaringol (Engl Ed) 2005; 71(6):776-782.



4. 

Treleaven J, Jull G, Lowchoy N. Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety. J Rehabil Med 2005; 37(4):219-223.



5. 

Heikkila H, Astrom PG. Cervicocephalic kinesthetic sensibility in patients with whiplash injury. Scand J Rehabil Med 1996; 28(3):133-138.



6. 

Treleaven J, Jull G, Sterling M. Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med 2003; 35(1):36-43.



7. 

Revel M, Andre-Deshays C, Minguet M. Cervicocephalic kinesthetic sensibility in patients with cervical pain. Arch Phys Med Rehabil 1991; 72(5):288-291.



8. 

Swinkels A, Dolan P. Regional assessment of joint position sense in the spine. Spine 1998; 23(5):590-597.



9. 

McNair PJ, Portero P, Chiquet C, Mawston G, Lavaste F. Acute neck pain: Cervical spine range of motion and position sense prior to and after joint mobilization. Man Ther 2006.



10. 

Armstrong BS, McNair PJ, Williams M. Head and neck position sense in whiplash patients and healthy individuals and the effect of the cranio-cervical flexion action. Clin Biomech (Bristol , Avon ) 2005; 20(7):675-684.



11. 

Chaudhry H, Findley T, Quigley KS, Bukiet B, Ji Z, Sims T et al. Measures of postural stability. J Rehabil Res Dev 2004; 41(5):713-720.



12. 

Gill J, Allum JH, Carpenter MG, Held-Ziolkowska M, Adkin AL, Honegger F et al. Trunk sway measures of postural stability during clinical balance tests: effects of age. J Gerontol A Biol Sci Med Sci 2001; 56(7):M438-M447.



13. 

Treleaven J, Jull G, Lowchoy N. Standing balance in persistent whiplash: a comparison between subjects with and without dizziness. J Rehabil Med 2005; 37(4):224-229.