Science professor giving lecture to class at the university
A new article in Neurology Education argues that it’s time for vestibular neurology—the study and treatment of dizziness, vertigo, and balance problems—to be recognized as a core skill for all neurology trainees.
Why this matters
Dizziness is one of the top reasons people seek neurological care, along with headaches and seizures. Yet, unlike headaches and seizures, vestibular conditions are not consistently taught as a basic competency for neurology residents around the world. This mismatch means many patients face delayed or incorrect diagnoses. For example, strokes that present with vertigo are twice as likely to be misdiagnosed, sometimes with devastating consequences.
Common vestibular conditions
The majority of patients who see neurologists with dizziness are experiencing one of three conditions:
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Vestibular migraine (VM) – affects about 3% of the population each year
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Benign paroxysmal positional vertigo (BPPV) affects about 1.6% of people annually
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Orthostatic hypotension (OH) – especially common in older adults
Because these conditions share overlapping symptoms, patients are often shuffled between neurology, ENT, and cardiology clinics, sometimes resulting in labels such as “not an ear problem” or “not a brain problem.” These delays can worsen symptoms or lead to chronic issues like Persistent Postural-Perceptual Dizziness (PPPD).
The solution: better training
The authors argue that every neurology trainee should spend several months learning to recognize and manage vestibular conditions, including hands-on bedside exams that can be more accurate than MRI scans in diagnosing acute strokes with dizziness. Training should also cover new tools such as video head-impulse testing, as well as genetics and neurophysiology.
Bottom line
For patients, this shift could mean faster answers, fewer misdiagnoses, and more effective care. For providers, it underscores the urgent need for vestibular neurology to transition from a niche specialty to the mainstream of neurological education and practice.
Source: https://www.neurology.org/doi/pdf/10.1212/NE9.0000000000200257
