[Chronic vestibular syndromes: Correct diagnosis and treatment]

Chronic dizziness is defined as dizziness or vertigo symptoms that are continuously present for more than 3 months. Typical complaints include persistent to-and-fro vertigo accompanied by postural imbalance and gait unsteadiness with an increased risk of falling. Patients often experience inadequate or inappropriate medical care despite being significantly impaired in their daily lives. Common vestibular causes include persistent peripheral vestibular disorders (such as bilateral vestibulopathy or incompletely compensated unilateral vestibulopathy), central vestibular syndromes (e. g., downbeat nystagmus with or without evidence of ataxia, dementia syndromes with cognitive-motor disorders), as well as non-organic functional disorders. A systematic medical history and a thorough clinical neurological examination - paying particular attention to the vestibular, oculomotor, cerebellar, sensory, and extrapyramidal systems, as well as cognitive function - are key to establishing the correct differential diagnosis. Even long-standing syndromes can often still be positively influenced by targeted physiotherapy, psychotherapy, or medication, leading to an improved quality of life for patients. This article provides a hands-on overview of the clinical characteristics of the most important organic and non-organic vestibular disorders underlying chronic dizziness as a primary symptom, as well as their specific effective treatment approaches.