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Delayed Vertigo After Mild Head Injury May Disrupt Daily Life, Indonesian Case Study Shows
A case study published in 2026 by Mu’afi Sinergi, Fanny Deviasih Krisnawati Sidanu, Aura Tussofi Mareta Cahyatika of Universitas Muhammadiyah Yogyakarta, together with Tri Wahyuliati, Wahyu Wihartono, and Luthfan Sumaryono from PKU Muhammadiyah Gamping Teaching Hospital, highlights how vertigo can emerge months after a seemingly minor head injury and significantly affect a patient’s quality of life. Published in the Jurnal Multidisiplin Madani (MUDIMA), the report documents the experience of a 63-year-old woman who developed recurrent vertigo months after a mild traumatic brain injury (mTBI), illustrating the need for earlier recognition of post-traumatic vestibular disorders and more comprehensive follow-up care.
The findings are important because mild traumatic brain injuries are often considered minor and may not receive long-term monitoring. However, the study shows that delayed symptoms can interfere with daily activities, emotional well-being, independence, and productivity, particularly among older adults.
Mild Head Injuries Can Have Lasting Effects
Traumatic brain injury is a major public health concern worldwide. Although severe cases attract the most attention, most head injuries are classified as mild. In Indonesia, head injuries account for a significant proportion of trauma-related medical cases, and many patients recover without hospitalization.
Yet recovery is not always complete.
Medical research has shown that some patients develop post-concussion syndrome, a condition involving persistent physical, cognitive, and emotional symptoms after a head injury. Among the most common complaints are dizziness, balance problems, and vertigo.
Previous studies cited by the authors indicate that approximately 10–15 percent of patients with mild traumatic brain injury experience post-concussion syndrome, while some studies report rates exceeding 35 percent. Vestibular disorders, which affect balance and spatial orientation, are among the most disruptive complications.
The researchers note that post-traumatic vertigo is frequently underdiagnosed because symptoms may appear weeks or months after the initial injury, making the connection difficult for both patients and clinicians to recognize.
How the Case Was Investigated
The study was conducted as a clinical case report at the Neurology Clinic of PKU Muhammadiyah Gamping Hospital in Yogyakarta.
Researchers retrospectively reviewed medical records, conducted patient interviews, and analyzed neurological and vestibular examination findings. The assessment included balance tests, positional vertigo examinations, and evaluation of the patient’s daily activities and psychosocial well-being.
The patient, a 63-year-old housewife, sought medical care after experiencing recurrent episodes of dizziness and vertigo that had persisted for two months. The symptoms occurred every two to three days and lasted approximately two minutes per episode.
Four months earlier, she had fallen in a bathroom, striking her head and briefly losing consciousness. Initial medical evaluations, including a CT scan, showed no significant abnormalities, and she initially appeared to recover without complications.
Key Findings
The case revealed several important clinical observations.
Symptoms Appeared Months Later
One of the most notable findings was the delayed onset of symptoms.
The patient developed recurrent vertigo approximately two months after the injury, despite having normal imaging results and no significant complaints immediately after the accident. Researchers note that this delayed presentation can complicate diagnosis because patients and healthcare providers may not associate the symptoms with the earlier injury.
Balance Problems Were Detectable
Neurological examination showed no major nerve abnormalities, but balance testing revealed vestibular dysfunction.
The patient demonstrated a positive Romberg test and abnormal balance responses, suggesting impairment of the vestibular system responsible for maintaining equilibrium. Although a standard positional vertigo test did not show classic findings, clinicians considered benign paroxysmal positional vertigo (BPPV) caused by trauma to be the most likely diagnosis.
Daily Activities Became More Difficult
The impact extended far beyond physical symptoms.
The patient reported reducing household responsibilities such as:
- Sweeping and mopping floors
- Washing clothes
- Cooking for extended periods
- Activities involving bending or rapid head movement
She also became increasingly dependent on family members for assistance with routine domestic tasks.
Anxiety and Fear Increased
Researchers observed significant psychosocial consequences.
The patient became fearful of falling again and worried about sudden vertigo episodes occurring while she was alone. These concerns led her to restrict physical activity and avoid certain situations, reducing both her confidence and independence.
Treatment Improved Symptoms
The patient received a combination of therapies, including:
- Three canalith repositioning (Epley) maneuvers
- Betahistine medication
- Education regarding activity modification
After one month of follow-up, she reported approximately 60 percent improvement in her vertigo symptoms. However, concerns about recurrence remained, and some limitations in daily activity persisted.
Why Post-Traumatic Vertigo Is Often Missed
According to the researchers, post-traumatic vertigo frequently escapes diagnosis because symptoms are diverse and often resemble other conditions.
Patients may report dizziness, imbalance, headaches, fatigue, or cognitive difficulties rather than classic vertigo symptoms. In addition, standard emergency evaluations after head injuries usually focus on identifying life-threatening complications rather than subtle vestibular dysfunction.
The study also notes that approximately 21 percent of patients with head injuries may develop BPPV within three months after trauma, a rate substantially higher than in the general population. This suggests a strong connection between head injury and later vestibular disorders.
Implications for Healthcare Practice
The findings have important implications for clinicians, rehabilitation specialists, and healthcare policymakers.
The researchers recommend that patients who experience persistent dizziness or balance disturbances after a mild head injury undergo more comprehensive vestibular assessment, even if initial scans and neurological examinations appear normal.
The study also highlights the value of multidisciplinary management involving neurologists, rehabilitation specialists, vestibular therapists, and psychosocial support services. Such collaboration may help patients recover more effectively and reduce long-term impacts on quality of life.
For older adults, early diagnosis may be especially important because recurrent vertigo increases the risk of falls, loss of independence, social isolation, and reduced productivity in daily life.
Academic Perspective
According to Mu’afi Sinergi and colleagues from Universitas Muhammadiyah Yogyakarta and PKU Muhammadiyah Gamping Teaching Hospital, recurrent vertigo after mild head injury should not be dismissed as a minor complaint. Their analysis suggests that post-traumatic vestibular disorders can emerge long after the initial injury, may present with atypical symptoms, and can substantially affect physical function, emotional well-being, and everyday productivity.
The authors conclude that greater awareness, early screening, and multidisciplinary treatment are essential for minimizing the long-term consequences of post-traumatic vertigo.
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