Disequilibrium

An important fact is that vertigo is the usual, but not the only, symptom pointing to the vestibular system. Disequilibrium (unsteadiness or loss of balance), without vertigo, can also be a sign of more chronic, insidious problems. In young and middle-aged patients with this symptom, certain specific diseases of the vestibular system should be ruled out. An acoustic

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neuroma, chronic luetic labyrinthine disease, or even demyelinating disease in the brainstem (i.e., multiple sclerosis), may be present.

In very elderly people, dysequilibrium is more likely to indicate nonspecific multisystem deficiency, including poor circulation, poor vision, and generalized neurologic deterioration. An important clinical point should be made here. A common treatment error often occurs with this category of patients: many physicians prescribe meclizine or a similar drug. This antihistamine will not help a degenerating vestibule, but will cause drowsiness! Be advised that meclizine is intended for nausea and true vertigo, not imbalance.

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