A 53-year-old female presented to the clinic with chronic dizziness described as feeling like she was on a rocking boat and headaches in her suboccipital region that began 5 months prior. The patient reported a history of vestibular neuritis 3 years prior to the onset of her symptoms that left her with a 33% deficit in the function of her right vestibular system. She stated that the dizziness was affecting her ability to function independently and hindering her from leaving the house without a family member for fear of losing her balance and falling. As a result, she was no longer able to perform activities such as exercising or going grocery shopping due to her symptoms.
Examination and Diagnosis
Physical examination and diagnostic testing identified impaired pursuit mechanisms and gaze instability in all planes, suboptimal optokinetic reflexes, skewed center of pressure, and a cantilever compensation during gait. The patient was diagnosed with central vestibular dysfunction.
Treatment
The patient was initially treated at a frequency of one day a week, undergoing three separate rounds of treatment each day. This frequency was maintained for four consecutive weeks (12 total hours of treatment), followed by a re-examination. Following the re-examination the patient was given home exercises to perform and advised to continue care at a frequency of one day per month with two separate hour-long rounds of treatment each visit to maintain progress.
Treatment consisted of diaphragmatic breathing exercises, cranial nerve neuromodulation, oculomotor exercises, complex movement exercises of the right upper and lower extremity proximal joints, interactive metronome training, insufflation, Red/NIR light therapy, and Bemer pEMF therapy.
Results
Following the completion of the initial course of treatment the patient reported a subjective 80% improvement in symptoms with complete resolution of brain fog, significant reduction in the frequency and severity of headaches, and significant reduction in the frequency and severity of her dizziness and balance disturbances. She stated that she had begun exercising again and felt comfortable leaving her house to grocery shop on her own.
Re-examination revealed moderate improvement in pursuit mechanisms, reduction in square wave jerk activity in all planes of gaze, optokinetic reflexes within normal limits, and complete resolution of abnormal center of pressure and cantilever compensation during gait.
Conclusion
A multi-modal functional neurology approach has been shown to be effective in the treatment and management of headaches and central vestibular dysfunction in a patient with a history of vestibular neuritis. Patients require an individualized plan of care and targeted treatment strategies to achieve optimal outcomes.