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Ben D. Lawson, PhD, is a Research Psychologist, US Army Aeromedical Research Laboratory (USAARL). Angus H. Rupert, MD, PhD, is a Research Scientist with USAARL. Amanda M. Kelley, PhD, was a Research Psychologist with USAARL when the manuscript was written; she is now affiliated with the National Highway Transportation Safety Administration.
Disclosure: We thank Linda-Brooke Thompson and Jillian Parker for their help with this manuscript. Views, opinions, or findings in this report are those of the author(s) and should not be construed as official Department of the Army positions, policies, or decisions, unless so designated by other official documentation. Citation of trade names does not constitute an official Department of the Army endorsement or approval of the use of such commercial items.
Military clinicians regularly examine personnel with posttraumatic stress (PTS), concussion, and/or mild traumatic brain injury (mTBI). For example, when a service member has suffered head injury and the loss of a comrade due to an explosive device, it may be difficult to determine which of the patient's problems originate from psychological reaction to traumatic stress versus organic medical conditions arising from head injury.
There is debate concerning the respective contributions of these problems to observed symptoms and deficits. It is outside the scope of this review to settle this complicated issue. Rather, our purpose is to ensure clinicians are aware that vestibular injury causes medical conditions that mimic, elicit, or exacerbate mental disorders. This point should be considered during differential diagnosis (perhaps with help from an otolaryngologist) to determine whether a mental disorder is purely psychological or originates with a head injury or other general medical disorder.1
Traumatic brain injury (TBI) is the phrase used to describe head injuries associated with explosive blast and acceleration/impact-related insult to the head associated with multiple, complex injuries.2 mTBI accounts for approximately 90% of diagnosed head injuries each year. mTBI is associated with headache, dizziness, vertigo, disequilibrium, or disorientation, typically without abnormal brain imaging results.3-5 Dizziness and vertigo are common in studies of mTBI and contribute disproportionately to disability.3,4 Luxon3 cites five studies where the incidence of these symptoms ranges from 40% to 62% after head injury. Vertigo is an illusion of self-motion suggestive of vestibular dysfunction, whereas dizziness is a nonspecific sense of disorientation,3 but either...