Vertigo, dizziness and imbalance
Vertigo is the false sense that the room or the body is spinning. Dizziness is a broader term that includes light-headedness, unsteadiness and disorientation. Imbalance without spinning points more toward the cerebellum, the sensory nerves, the inner ear or the gait system.
The timing and trigger matter. Brief vertigo when rolling over in bed suggests BPPV. Severe vertigo lasting hours to days with nausea suggests vestibular neuritis. Recurrent episodes with hearing fullness, tinnitus or hearing loss suggest Meniere's disease. Episodes with headache and light sensitivity suggest vestibular migraine.
- Vertigo with double vision, slurred speech, weakness or numbness — emergency
- Sudden hearing loss in one ear — urgent same-day assessment
- Vertigo with fever, neck stiffness or severe headache
- New imbalance with walking difficulty or repeated falls
- Dizziness with fainting, chest pain or palpitations
Related: Neurology → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
What the assessment covers
The consultation records the duration, frequency and triggers of symptoms, associated hearing change, tinnitus, headache, nausea, vomiting, visual symptoms and falls. Medicines, blood pressure, hydration, sleep and anxiety are reviewed.
The examination includes eye movements, nystagmus, Dix-Hallpike and other positional tests where appropriate, gait, balance and a neurological screen. Vestibular function testing, audiometry, MRI or vascular imaging may be arranged when a central cause or hearing loss is suspected.
- Distinguish peripheral vestibular disease from brainstem or cerebellar causes
- Check for stroke risk factors and medication effects
- Assess falls risk, gait and vision
- Coordinate with ENT, audiology and physiotherapy
Common causes
Peripheral causes include BPPV, vestibular neuritis, Meniere's disease and vestibular migraine. Central causes include stroke or TIA, cerebellar disorders, multiple sclerosis and, less commonly, acoustic neuroma or other posterior fossa lesions.
Systemic causes such as low blood pressure on standing, dehydration, anaemia, thyroid disease, anxiety and medication side effects are also common. The same symptom can have more than one contributor, especially in older adults.
Treatment and balance rehabilitation
Treatment depends on the cause. BPPV is treated with repositioning manoeuvres. Vestibular neuritis is managed with short-term symptom relief and gradual vestibular rehabilitation. Meniere's disease and vestibular migraine need specific preventive plans. Persistent postural-perceptual dizziness (PPPD) responds to vestibular rehabilitation and CBT-informed care.
Falls prevention, home safety, vision review and strength and balance exercises are important in older adults. Dr. Yadav coordinates with ENT, audiology and physiotherapy rather than treating dizziness as a single disease.
Access and booking
Appointments are at Kathmandu Neurology Clinic & Cognitive Center, 117 Lal Durbar Marg, Kathmandu, opposite Yak & Yeti Hotel. Call +977-9747736624 or use /book-appointment. Bring prior reports, imaging and a medication list.