Affiliations: Neuro-otology Unit, Division of Neuroscience and
Mental Health, Imperial College London, Charing Cross Hospital, London, UK
| Neurology Department, Schlosspark Klinik, Berlin,
Germany
Abstract: In this review we present a pragmatic approach to the patient with
chronic vestibular symptoms. Even in the chronic patient a retrospective
diagnosis should be attempted, in order to establish how the patient reached
the current situation. Simple questions are likely to establish if the chronic
dizzy symptoms started as benign paroxysmal positional vertigo (BPPV),
vestibular neuritis, vestibular migraine, Meniere's disease or as a brainstem
stroke. Then it is important to establish if the original symptoms are still
present, in which case they need to be treated (e.g. repositioning maenouvres
for BPPV, migraine prophylaxis) or if you are only dealing with chronic dizzy
symptoms. In addition the doctor or physiotherapist needs to establish if the
process of central vestibular compensation has been impeded due to additional
clinical problems, e.g. visual problems (squints, cataract operation),
proprioceptive deficit (neuropathy due to diabetes or alcohol), additional
neurological or orthopaedic problems, lack of mobility or confidence, such as
fear of falling or psychological disorders. A general neurological examination
should also be conducted, amongst other reasons to make sure your patient's
`chronic dizziness' is not due to a neurological gait disorder. Treatment of
the syndrome of chronic dizziness is multidisciplinary but rehabilitation and
simple counselling should be available to all patients. In contrast, vestibular
suppressants or tranquilisers should be reduced or, if possible, stopped.
