Vertigo is the sensation of movement or spinning, which is distinct from general lightheadedness and arises from a disruption in the body’s complex balance system. Neurologists are medical doctors who specialize in disorders of the nervous system, including the brain, spinal cord, and all associated nerves. Because the nervous system controls the processing of balance information, a neurologist is qualified to diagnose and manage conditions that cause vertigo.
The Neurologist’s Expertise in Balance Disorders
A neurologist’s primary focus in diagnosing balance issues is the central nervous system (CNS) component of the vestibular system. Balance relies on a continuous exchange of sensory data between the inner ear, the eyes, and the brain. The brainstem and the cerebellum are the main CNS structures responsible for processing this vestibular information.
Neurological consultation is important when the spinning sensation originates within these central structures rather than the inner ear itself. The neurologist’s expertise allows for the identification of conditions such as stroke, multiple sclerosis, or vestibular migraine, which manifest as vertigo. This focus contrasts with that of an ear, nose, and throat (ENT) specialist, who concentrates on the peripheral, or inner ear, components of the balance system.
Diagnostic Procedures Used by Neurologists
The diagnostic process begins with a detailed clinical assessment, focusing on the patient’s medical history and the characteristics of the vertigo episodes. A thorough neurological examination follows, which includes testing coordination, gait, and deep tendon reflexes. A specific component involves precise gaze testing, where the neurologist observes eye movements for involuntary jerking motions known as nystagmus, which points toward the location of the problem.
Neurologists frequently utilize a structured bedside assessment called the HINTS examination, which involves the Head Impulse Test, the observation of Nystagmus, and the Test of Skew. The Head Impulse Test assesses the vestibulo-ocular reflex by rapidly turning the patient’s head while they fix their gaze, helping to distinguish between central and peripheral causes. If the clinical picture suggests a serious central cause, such as a stroke or tumor, the neurologist will order imaging studies like Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans to visualize the brain and brainstem structure.
Specialized testing, such as Videonystagmography (VNG) or Electronystagmography (ENG), may also be ordered to objectively record eye movements and evaluate the function of the inner ear and central pathways. The Dix-Hallpike maneuver, which involves moving the patient from a sitting to a lying position with the head turned, is a practical test used to provoke positional vertigo. The results from these procedures provide objective data to complement the clinical exam, guiding the neurologist toward the correct diagnosis.
Central vs. Peripheral Vertigo: Determining the Source
The most important distinction a neurologist makes is classifying the vertigo as either central or peripheral. Peripheral vertigo arises from issues in the inner ear or the vestibular nerve, such as Benign Paroxysmal Positional Vertigo (BPPV) or vestibular neuritis. In contrast, central vertigo is caused by dysfunction in the brain, specifically the cerebellum or brainstem, which process the balance signals.
Symptoms often provide the first clue: peripheral vertigo typically presents with a sudden, intense spinning sensation, often associated with hearing changes or tinnitus. Conversely, central vertigo can be less dramatic and more constant, manifesting as a persistent sense of unsteadiness or imbalance. The neurologist interprets the nystagmus examination results to localize the source, as central nystagmus may change direction when the patient changes their gaze, while peripheral nystagmus typically beats in only one direction.
The presence of associated neurological symptoms, such as double vision, slurred speech, or limb weakness, is a strong indicator of a central cause requiring immediate attention. Conditions like a cerebellar stroke, which affects the coordination center of the brain, are primary concerns in central vertigo diagnosis.
Neurological Management and Treatment Approaches
Once a diagnosis is established, the neurologist determines the appropriate management strategy based on the source of the vertigo. For acute central causes, such as inflammation from multiple sclerosis or a recent stroke, treatment focuses on managing the underlying neurological condition. This often involves the use of immunosuppressants or specific medications to limit neurological damage and balance disruption.
In cases of vestibular migraine, a common central cause of recurrent vertigo, the neurologist prescribes prophylactic medications to reduce the frequency and severity of attacks. These preventive treatments may include beta-blockers, calcium channel blockers, or certain antiepileptic drugs. For immediate symptom relief during acute episodes, vestibular suppressants or anti-nausea drugs can be used, though long-term use is discouraged as they can delay the brain’s natural compensation process.
The neurologist also coordinates care, referring patients to other specialists as needed. While a neurologist may diagnose a common peripheral cause like BPPV, they often refer the patient for physical therapy to receive canalith repositioning maneuvers. For chronic balance issues, the neurologist may recommend vestibular rehabilitation therapy, a specialized form of physical therapy designed to improve balance and gaze stability through targeted exercises.