Dizziness

Abstract

<h2>Abstract</h2> Dizziness has many otological, neurological and medical causes, whereas the term ‘vertigo' is more specific and usually implies a vestibular disorder. Balance is maintained by sensory inputs from the visual, proprioceptive and vestibular systems. This information is integrated in the CNS and any mismatch between these sensory inputs can lead to vertigo. Dizziness from otological disorders often causes acute onset vertigo, whereas neurological causes often present with insidious imbalance. Common causes of dizziness include peripheral vestibular dysfunction, Benign positional paroxysmal vertigo, Ménière's syndrome and migraine. Clinical evaluation of dizziness should include otoscopy, tuning-fork tests, examination of eye movements, stance, gait and the Hallpike test. Investigations such as caloric testing and electro/videonystagmography help to confirm the presence of a lesion, lateralize it, and differentiate central from peripheral causes. After an acute vestibular insult, symptoms of dizziness get better by ‘compensation' that involves central mechanisms and substitution of sensory inputs. Acute vertigo is treated with vestibular sedatives, which should be tapered as soon as possible to allow vestibular compensation. Drug treatment is available for migraine-associated dizziness, Ménière's disease and central vestibular disorders causing oscillopsia. Dizziness from vestibular dysfunction can be effectively managed by vestibular rehabilitation exercises, either customized or generic (Cawthorne-Cooksey exercises). Recently, optokinetic stimulation has been used to promote compensation. Specific manoeuvres (Epley's) are very effective in benign positional paroxysmal vertigo. Management of vestibular disorders is now being consolidated in ‘one-stop' clinics that are piloted at various sites in the UK.