Journal of Neurology, Neurosurgery, and Psychiatry 1982;45:126-130 Physiological basis for enduring vestibular symptoms

SUMMARY Four examples of patients who sustained a vestibular insult and did not fully recover over a prolonged period are described. The reasons for this failure of compensation are discussed in relation to the experimental literature, particularly that concerning the importance of extra-vestibular inputs upon the vestibular system. Vertigo and dizziness are among the most frequent complaints of patients presenting to the neurologist. In the majority the symptoms are relatively short-lived. In a few this is not the case. This latter group often become increasingly disabled and consult numerous physicians who, because of the paucity of neurological signs, frequently conclude that the patient is primarily suffering from a psychiatric condition. Whilst this decision is sometimes justified, it is not always so. Over the past two decades the mechanisms of recovery from acute vestibular dysfunction have been clarified. In this paper we review some aspects of this compensation and draw attention to the ways in which it may be prevented by alteration of visual and somataesthetic sensory input and central nervous system disease. We further emphasise how neuro-otological testing can often demonstrate abnormalities in patients who are apparently without objective signs of neurological dysfunction. Four case histories are presented as illustrative examples of some of the reasons for failure of recovery from vestibular dysfunction. Case reports Case 1, BM, A99033 This woman was seen at the age of 40 years (1978) with a two year history of incapacitating vertigo. She experienced sensations of floating, detachment and vertigo and could not move about without accentuating her symptoms. Walking produced a sensation of the ground being unsteady and she avoided places crowded with movin