Objective: Subtle complaints of visual-vestibular mismatch may not be elicited in an initial history-taking. Clinicians must be familiar with the nature of these complaints when assessing whiplash patients because other injuries may predominate and patients do not volunteer these more subtle complaints, which may be persisting and sometimes debilitating.
Study design: A retrospective case review was performed.
Setting: The study was conducted at a tertiary/quaternary referral clinic.
Patients: Patients with whiplash, mild head injury, or both were referred for assessment of symptoms persisting for at least 2 years after their injury.
Interventions: A full history; otolaryngologic examination; including assessment of eye movements, corneal reflexes, and gait; investigation including electronystagmography and computerized dynamic posturography; and history-taking and detailed recording of related complaints were performed immediately before diagnostic workup.
Main outcome measures: Many patients had more subtle complaints, which we now recognize as indicative of vestibular pathology, that have not previously been described in detail in the literature and are often generalized using terms such as "dizziness" or "lightheadedness." It is important to take a detailed history from these patients to delineate their more subtle complaints, because their symptoms frequently do not "fit" into traditional syndromes.
Results: Complaints verbalized by patients were tabulated. On more careful analysis, they can be identified as arising from a mismatch between vestibular information and other sensory information used to maintain balance.
Conclusions: Many patients with the standard vestibular syndromes have the same subtle complaints (apart from the standard vertiginous complaints) that patients with whiplash and minor head injury verbalize. The similarity of the complaints in the two groups indicate that the subtle symptoms are caused by underlying vestibular disease.