Diagnosing the cause of balance disorders can be challenging. Often – especially in elderly patients – there may be more than one pathology in more than one system.
Vertigo is a hallucination of movement produced by an underlying disorder of the vestibular system. The disturbance may be peripheral (in the ear, otological) or central (central nervous system). There are many systems that contribute to and are crucial to the control and maintenance of balance. If any one of these systems is affected this can result in the patient experiencing a balance disorder. Some of the conditions that can contribute to balance disorders are shown in Figure 13.1.
Presentation
Good history taking is the main diagnostic tool for diagnosing the underlying origin of a balance disorder. Patients will use various terms to describe imbalance, e.g. ‘dizzy spells’, ‘funny turns’ and ‘vertigo’. It is important to differentiate between the following and establish exactly what the patient is describing:
- Vertigo: hallucination of movement (due to vestibular disorders)
- Light headedness: feeling faint (often due to cardiovascular disturbance)
- Unsteadiness
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