Correlation between Ocular and Vestibular Abnormalities and Convergence Insufficiency in Post-Concussion Syndrome

ABSTRACT

The vestibular and oculomotor/visual systems are commonly affected in post-concussion syndrome (PCS). Convergence insufficiency (CI) is the most common ocular abnormality after concussion. Electrovestibulography (EVestG) is a relatively new non-invasive method that measures the peripheral vestibular responses; it has shown abnormal vestibular responses in a PCS. Here, we report the results of investigating the correlation between the vestibular and oculomotor systems in PCS population using EVestG and CI measures. Forty-eight PCS patients were tested using EVestG, out of which 20 also completed the Rivermead post-concussion questionnaire (RPQ). An EVestG feature (Field Potential (FP)-area) was extracted from the stationary part of the EVestG signals. A neuro-ophthalmologist (author BM) measured participants’ CI at near vision using cross-cover examination and a prism-bar. Results indicate: (1) vestibular abnormality (i.e. FP-area) and CI values are significantly correlated in PCS (R = 0.68, p < .01), and (2) there are significant correlations between severity of concussion (i.e. RPQ3) and CI (R = 0.70, p < .01) and between RPQ3 and FP-area (R = −0.56, p < .02). To the best of our knowledge, this is the first study that objectively demonstrates a significant positive correlation between the CI and vestibular systems’ abnormality. These findings are scientifically important as they help localise the pathology of PCS, and are clinically valuable as they help physicians in their decision-making about PCS diagnosis and rehabilitation strategies.

KEYWORDS:

• Mild traumatic brain injury
• mTBI
• concussion
• post-concussion syndrome
• PCS
• electrovestibulography
• EVestG
• vergence eye movement
• convergence insufficiency
• depression

Declaration of interest

The author BL is a consultant to the supporting company (Neural Diagnostics Pty. Ltd.).

Glossary

AP: action potential

CI: convergence insufficiency

EVestG: Electrovestibulography

EVS: efferent vestibular system

FEF: frontal eye field

INO: internuclear ophthalmoplegia

LGN: lateral geniculate nucleus

LPCS: long-term PCS

MLF: medial longitudinal fasciculus

mTBI: mild traumatic brain injury

NEER: neural event extraction routine

NRTP: nucleus reticularis tegmenti pontis

PCS: post-concussion syndrome

RPQ: Rivermead post-concussion questionnaire

RPQ3: score of first three symptoms of RPQ

RPQ13: score of last thirteen symptoms of RPQ

SOA: supraoculomotor area

SPCS: short-term PCS

VOMS: vestibular/ocular motor screening

VOR: vestibule-ocular reflex

Supplementary material

Supplementary materials for the article can be accessed on the publisher’s website.