Dizzy in the supermarket aisle
| Patient | 28F, subacute phase |
|---|---|
| Injurymoderate TBI; post-traumatic vestibular and ocular-motor complaints | |
| Severity | Worst GCS 14 |
| Days since injury | 42 |
| Before the injuryIndependent. Graphic designer — screen work all day. | |
| Also on the chartMigraine history, well controlled before the injury | |
| PrecautionsExercise and exposure dosed below symptom flare; Screen work paced — the job is the provocative environment | |
Test yourself
What does the assessment start with?
The teaching
After TBI, dizziness is rarely one thing. The VOMS separates the ocular-motor, VOR and visual-motion systems so the treatment matches the finding: adaptation for the VOR, habituation for the visual sensitivity, and the canal maneuvers reserved for the story that earns them — because post-traumatic BPPV is real and coexists. What you do with it: screen the systems, treat the provoked systems with graded exposure, and keep the Hallpike loaded for the positional story.
- Continuous unprovoked vertigo with spontaneous nystagmus — that is an acute vestibular syndrome, a different work-up
- New hearing loss on one side — refer for audiovestibular assessment
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Mucha A et al. A brief Vestibular/Ocular-Motor Screening (VOMS) assessment to evaluate concussions. Am J Sports Med. 2014. Ellis MJ et al. Vestibulo-ocular dysfunction in pediatric sports-related concussion. J Neurosurg Pediatr. 2015 · Kontos AP et al. A randomized controlled trial of precision vestibular rehabilitation in adolescents following concussion. J Pediatr. 2021. Management of Concussion-mild Traumatic Brain Injury Working Group. VA/DoD clinical practice guideline. 2021 · Bhattacharyya N et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017. Mucha A et al. A brief Vestibular/Ocular-Motor Screening (VOMS) assessment to evaluate concussions. Am J Sports Med. 2014