Dizziness is a complaint wherein the patient tries to describe the subjective disturbance in his or her orientation in space. Dizziness may signify one or more of the following sensations to the patient.

•  A sensation of rotation.

•  A sensation of faintness & impending unconsciousness.

3. Disequilibrium.

4. Light-headedness & weakness.

•  Uneasiness, insecurity & confusion.

This large & confusing list of symptoms is due to the fact that subjective orientation in space is controlled by a complex system that involves the following:

•  The vestibular labyrinth- the inner ear ( semi-circular canals & utricle ).

•  The eyes (optokinetic).

3. The proprioceptive system (touch and pressure system – spinal cord).

4. Central co-ordinating mechanism ( cerebellum ).

When the 3 primary systems controlling equilibrium (optokinetic, statokinetic & proprioceptive) are intact, we are correctly oriented in space & are stable. This stability is achieved by learning, experience & reflex activity. Any abnormality in any of these systems will disturb the equilibrium. The physician has to establish certain criteria in order to effectively diagnose the problem & treat it appropriately. The first step in doing so is the insight gained by taking a good history.

The following points should be emphasised on in the history:

•  Is the vertigo rotational or non-rotational?

•  Any associated disturbance in hearing.

•  The pattern of dizziness.

•  The degree of dizziness.

•  Any associated neurological disturbances.

•  History of drug usage.

Examination of the patient should include the following:

•  B.P. in standing & supine position.

•  Nystagmus – a rapid involuntary movement of the eyes (both spontaneous & induced).

•  ENT exam. including audiogram, impedance & BERA.

•  Cardiovascular system.

•  Central nervous system.

•  Haematology including serologic determination.

The physician should always rule out psychiatric disturbances & functional vertigo .

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