Vertigo and dizziness are common neurological complaints that encompass a broad range of disorders affecting balance, spatial orientation, and perception of motion. Vertigo refers specifically to the false sensation of movement, typically spinning, whereas dizziness is a nonspecific term that may include lightheadedness, imbalance, or presyncope. Accurate neurological differentiation is essential, as etiologies range from benign peripheral vestibular conditions to serious central nervous system pathology.

Peripheral vestibular disorders originate from dysfunction of the inner ear or vestibular nerve. Common causes include benign paroxysmal positional vertigo, vestibular neuritis, and Ménière-type disorders. These conditions typically present with episodic vertigo triggered by head movement, associated nausea, and imbalance, often without focal neurological deficits. In contrast, central vertigo arises from brainstem or cerebellar pathology and may present with persistent vertigo, gait ataxia, diplopia, dysarthria, or other neurological signs.

Neurological evaluation of vertigo and dizziness begins with a detailed history focusing on symptom onset, duration, triggers, associated auditory or neurological features, and progression. Physical examination includes assessment of eye movements, nystagmus characteristics, gait stability, and cerebellar function. Bedside maneuvers help differentiate peripheral from central causes and guide further investigation.

Neuroimaging is indicated when central pathology is suspected or when symptoms are atypical, progressive, or associated with neurological deficits. Vestibular testing and audiological assessment may be used to characterize peripheral disorders. Accurate diagnosis is critical, as management strategies differ significantly between etiologies.

Treatment of vertigo and dizziness is cause-specific. Peripheral vestibular disorders may respond to repositioning maneuvers, short-term vestibular suppressants, and vestibular rehabilitation. Central causes require targeted neurological management addressing the underlying pathology. Chronic dizziness often benefits from structured rehabilitation and avoidance of long-term suppressive medication.

Persistent vertigo can significantly impair daily function, increasing fall risk and reducing quality of life. Neurological follow-up ensures symptom resolution, prevention of recurrence, and identification of evolving central disorders. A structured, evidence-based approach is essential for effective management of balance disorders.