Chronic Dizziness

Yoon-Hee Cha, MD, FAAN Neuro-otology p. 420-446 April 2021, Vol.27, No.2 doi: 10.1212/CON.0000000000000932
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PURPOSE OF REVIEW Determining the etiology of disorders that manifest with chronic dizziness can seem a daunting task, but extracting some basic elements of the patient’s history can reduce the differential diagnosis significantly. This includes determining initial triggers, timing of symptoms, associated features, and exacerbating factors. This article covers distinct causes of chronic dizziness including persistent postural perceptual dizziness, mal de débarquement syndrome, motion sickness and visually induced motion sickness, bilateral vestibulopathy, and persistent dizziness after mild concussion.

RECENT FINDINGS To date, none of the disorders above has a cure but are considered chronic syndromes with fluctuations that are both innate and driven by environmental stressors. As such, the mainstay of therapy for chronic disorders of dizziness involves managing factors that exacerbate symptoms and adding vestibular rehabilitation or cognitive-behavioral therapy alone or in combination, as appropriate. These therapies are supplemented by serotonergic antidepressants that modulate sensory gating and reduce anxiety. Besides expectation management, ruling out concurrent disorders and recognizing behavioral and lifestyle factors that affect symptom severity are critical issues in reducing morbidity for each disorder.

SUMMARY Many syndromes of chronic dizziness can be diagnosed by recognition of key features, although many symptoms overlap between these groups. Symptoms may be manageable and improve with time, but they are often incompletely relieved.

Address correspondence to Dr Yoon-Hee Cha, University of Minnesota, 717 Delaware St SE, Minneapolis, MN 55414, [email protected].

RELATIONSHIP DISCLOSURE: Dr Cha has received research/grant support from the Brain & Behavior Research Foundation, the Mal de Debarquement Syndrome (MdDS) Balance Disorder Foundation, MnDrive Scholars, National Institutes of Health/National Institute of General Medical Sciences (P20 GM121312), the National Science Foundation/Established Program to Stimulate Competitive Research (R2 Track-2 1539068), Springbank Foundation, and Totts-Gap Foundation.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Cha discusses the unlabeled/investigational use of selective serotonin reuptake inhibitors in the treatment of mal de débarquement syndrome and persistent postural perceptual dizziness.

© 2021 American Academy of Neurology.