Dr. Raffaello BonacchiNeurologist · Neuroradiologist IT

Vertigo and balance disorders

The term vertigo covers different sensations: the room spinning, unsteadiness, imbalance or feeling light-headed. Understanding exactly what kind of disturbance it is, is the first step towards finding the cause.

The most common causes

Many cases of vertigo originate in the inner ear (peripheral causes), others in the central nervous system.

  • Benign paroxysmal positional vertigo: short episodes triggered by head movements, for example turning over in bed.
  • Vestibular neuritis: intense, prolonged vertigo, often with nausea, which gradually improves over days.
  • Vestibular migraine: episodes of vertigo in people with migraine, even without headache.
  • Central causes: rarer, such as disorders of the cerebral circulation, demyelinating diseases or other lesions of the brainstem and cerebellum.

When to see a neurologist

A neurological visit is indicated when vertigo recurs, lasts a long time, or is associated with headache or persistent unsteadiness when walking.

Sudden vertigo with double vision, difficulty speaking or swallowing, or weakness or tingling on one side of the body should be assessed urgently, because it may be a sign of stroke.

Diagnosis

Diagnosis is based on the interview and a targeted neurological examination, including assessment of eye movements, balance and gait. Depending on the clinical suspicion, brain MRI, Doppler ultrasound of the neck vessels or an ENT assessment may be useful.

Treatment

Treatment depends on the cause: repositioning manoeuvres for positional vertigo, vestibular rehabilitation, preventive treatment for vestibular migraine, or treatment of the underlying neurological disease.

Neurological visit in Milan, Osio Sotto (Bergamo) and Pistoia

Dr. Raffaello Bonacchi, neurologist and neuroradiologist, sees patients in Milan, Osio Sotto (Bergamo) and Pistoia, and also offers online consultations with review of tests and images already performed.

Frequently asked questions

Is vertigo caused by the neck?

The neck is often blamed, but it is rarely the real cause. More often the origin is in the inner ear or, less frequently, in the central nervous system: this is why a careful assessment is important.

The information on this page is for general information only and does not replace a medical visit. For sudden or severe symptoms call 112 or go to the Emergency Department.