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The vestibular system is responsible for maintaining a stable perceptual frame of reference whenever we are in motion or when things are in motion around us.  We are kept in balance and oriented in space by a complex feedback system that integrates the rate and angle of our motion into our positional adjustments and our visual perceptions so that we and our world remain stable (Ciuffreda and Tannen, 1995).  This system performs this complex task through 5 end-organs within the temporal bone-the three semicircular canals, sensing angular rotation, and the saccule and utricle, sensing gravity and linear acceleration.  The central projections to the brain are complex and include afferent and efferent connections from and to a variety of areas of the body, including eye muscles (oculomotor pathways), allowing for smooth tracking of eye movements (Kapoor and Ciuffreda, 2006), and neck and spinal muscles, keeping the head and body correctly oriented.

Vestibular system symptoms can be destabilizing and disorienting.  Acutely, patients may experience vertigo, but over time, this often resolves into a more subtle sense of instability and imbalance.  A car ride or a sudden turn may be sufficient to provoke a worsening of symptoms that persists for hours or even days.  Dysfunction of the oculomotor reflex results in visual distortion, photosensitivity, and an inability to keep an object stabilized visually.  Patients with oculomotor reflex abnormalities often experience photophobia and develop the fatigue and secondary headaches that are commonly seen in PCS. These patients have particular difficulty with the sustained visual focusing and tracking required in the process of reading. They are able to read, but they have difficulty sustaining the reading process for very long.

It has been suggested that the vestibular system may be more sensitive to rapid acceleration/deceleration trauma than the brain and that central vestibular system symptoms often recover slowly and incompletely (Hain et.al., 2007).  Despite the high prevalence of vestibular system dysfunction in head trauma cases, vestibular symptoms are usually incorporated into a post-concussion syndrome diagnosis with little additional consideration, evaluation or treatment.  Further, vestibular system symptoms are seldom questioned when they arise within the context of a PCS diagnosis.
 
 
 
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