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Vestibular post-concussion symptoms — MRCP Part 1 MCQ

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HardConcussionVestibular post-concussion symptomsMRCP Part 1

A rugby player has normal structural imaging after concussion. Twelve days later he has persistent dizziness, occipital headache and neck pain provoked by head movement. Examination suggests cervical and vestibulo-ocular dysfunction without a new focal neurological deficit. What is the most appropriate active management?

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Correct answer: D — Targeted cervicovestibular rehabilitation with graded activity

The best answer is “Targeted cervicovestibular rehabilitation with graded activity”. The Amsterdam consensus recommends cervicovestibular rehabilitation when dizziness, neck pain or headache persists beyond 10 days, guided by the identified cervical and vestibular deficits. Prolonged strict rest can delay recovery; graded symptom-limited activity is now favoured. Vestibular suppressants may obscure compensation and do not correct the deficit, repeat CT is not routinely indicated without new red flags, and contact return requires staged progression and clinical clearance.

Reference: Amsterdam 2022 international concussion consensus: https://pubmed.ncbi.nlm.nih.gov/37316210/