Disfunções oculomotoras e queixa de tontura em indivíduos com lesão cerebral traumática: uma revisão sistemática

Abstract

Introduction: Traumatic brain injury can result in oculomotor and vestibular dysfunctions, impacting balance, gaze stabilization, and sensory integration, often associated with symptoms of dizziness. Different pathophysiological mechanisms have been proposed to explain the coexistence of these alterations, however, the detailed characterization of these deficits is not yet consolidated. Objective: To describe characteristics of oculomotor dysfunctions and complaints of dizziness in individuals with traumatic brain injury. Method: This is a systematic review of the literature, conducted according to the PRISMA checklist and registered in PROSPERO (CRD42021289745). The search was performed in the PubMed and BVS databases, using MeSH descriptors. Analytical observational studies that evaluated eye movements and dizziness in individuals with traumatic brain injury were selected. Studies with animals, use of medications, samples smaller than ten participants, and non-indexed publications were excluded. Methodological quality and risk of bias were assessed using tools from the Joanna Briggs Institute. Results: The survey resulted in 11 articles, of which seven were included. These were published between 2015 and 2024 and involved 460 individuals, mostly men (18-70 years old) with concussion and traumatic brain injury. Dizziness was assessed using the Dizziness Handicap Inventory in all studies, with scores being significantly higher in individuals with traumatic brain injury. Deficits in saccades, smooth pursuit, and vestibulo-ocular reflex were identified, in addition to alterations in tests such as nystagmus, vertical and torsional alignment nullification, Gaze Stabilization Test, and ocular vestibular evoked myogenic potential. Some studies have described a relationship between the Dizziness Handicap Inventory and a greater number of oculomotor dysfunctions. Conclusion: The results of this review reinforce that individuals with traumatic brain injury, in addition to complaining of persistent dizziness, often present oculomotor dysfunctions, suggesting that the integrity of the oculomotor system is frequently compromised in these cases.