Walsh & Hoyt: Vestibular Symptoms: Vertigo, Oscillopsia, and Tilt

Patients with disorders that affect the vestibular system may complain of disequilibrium or unsteadiness, symptoms that reflect imbalance of vestibular tone. A common complaint of patients with vestibular imbalance is vertigo, the illusory sensation of motion of self or of the environment. Vertigo usually reflects a mismatch between vestibular, visual, and somatosensory inputs concerning the position or motion of ones body in space. Although it is helpful to question patients with vertigo as to the direction of their vertiginous illusions, they are often uncertain because their vestibular sense indicates head rotation in one direction, whereas their eye movements (the slow phases of vestibular nystagmus) are producing visual image movements that connote rotation of the head in the opposite direction. It is best to evaluate the vestibular sense alone by asking the patient about the perceived direction of selfrotation with the eyes closed, thus eliminating conflicting visual stimuli