Dizziness and Balance Disorders
What is dizziness?
Dizziness is one of the most common symptoms in neurology. It describes a disturbance of spatial orientation or a false perception of movement. Dizziness is not a condition in its own right but a symptom that can have many different causes.
Symptoms
Rotational vertigo
- Feeling as if the surroundings are spinning (as on a carousel)
- Often accompanied by nausea and vomiting
- Can last from seconds to hours
Unsteady dizziness
- Feeling of unsteadiness, as if the ground is swaying
- Unsteady gait
- Often persistent or over longer periods
Light-headed dizziness
- Diffuse feeling of light-headedness or reeling
- Blurred vision
- Concentration problems
Causes
Peripheral causes (inner ear/organ of balance)
- Benign paroxysmal positional vertigo (BPPV) – most common cause of dizziness, brief attacks of rotational vertigo with head movements
- Vestibular neuritis – acute one-sided failure of the organ of balance
- Menière’s disease – attacks of rotational vertigo with hearing loss and tinnitus
Central causes (brain)
- Circulatory disorders in the brainstem or cerebellum
- Multiple sclerosis
- Migraine-associated dizziness (vestibular migraine)
Other causes
- Medication side effects
- Blood pressure fluctuations (orthostatic dizziness)
- Functional (psychogenic) dizziness
- Polyneuropathy (unsteady gait due to impaired deep sensation)
Diagnostics
- Detailed medical history – type of dizziness, duration, triggers, accompanying symptoms
- Neurological examination – coordination, gait testing, eye movements (nystagmus)
- Positioning tests – Dix-Hallpike maneuver to detect positional vertigo
- Neurosonography – ultrasound of the blood vessels supplying the brain to rule out circulatory disorders
- EEG – when an epileptic cause is suspected
- Laboratory tests – blood count, thyroid values, blood sugar
Treatment
Benign paroxysmal positional vertigo
- Repositioning maneuvers (Epley maneuver, Sémont maneuver) – often immediate improvement
Vestibular neuritis
- Cortisone pulse therapy in the acute phase
- Early balance training (vestibular rehabilitation)
Vestibular migraine
- Migraine prophylaxis (beta blockers, Topiramate)
- Avoidance of trigger factors
General measures
- Balance training and vestibular rehabilitation
- Physiotherapy
- Adjustment of medications that trigger dizziness
- Treatment of the underlying condition
Last updated: 2026-07-04