Symptoms include oscillopsia and ataxia, often without vertigo. In the management of such a case, it is important to advise the patient to avoid any agents that may suppress the vestibular system, such as meclizine. It is also important for them to avoid anticholinergic agents such as many of the tricyclic antidepressant medications. Ototoxic agents must be avoided above all, particularly gentamicin. Vestibular rehabilitation physical therapy is usually helpful, but full recovery is never attained in many patients.
Recovery depends on the degree of vestibular loss and on the individual's ability to compensate.
Central Dizziness Central dizziness is relatively less common than otologic dizziness but, as it is most often secondary to vascular events involving the cerebellum and brainstem, it may be a harbinger of dangerous associated conditions. Dizziness caused by vertebrobasilar migraine, common in mid-adulthood, is much less prevalent in the elderly. Patients with central vertigo are often distressed by ataxia, nausea, and illusions of motion for years. Although it is uncommon for seizures to present as dizziness, they deserve a special mention because they respond well to treatment with anticonvulsant medication. The patient may also have a history of loss of consciousness.