Neurological disorders of gait may present as ataxia. Check for a positive rhombergs sign.
Ataxia is an unsteady and clumsy motion of the limbs or trunk due to a failure of the gross coordination of muscle movements.
Several types of ataxia are possible, including:
Specific ataxias include:
People with suspected ataxia should be referred to a neurologist for further evaluation.
Dizziness associated with a hallucination of motion:
A general medical history will be required, which should include a review of medications that may cause dizziness or postural hypotension.
Consider referral to Physiotherapy for vestibular rehabilitation (see below)
If symptoms persist consider referral to ENT
Patients may refer to the sensation of dizziness from pre-syncope, hyperventilation or anxiety as 'giddiness', 'dizziness' or 'light-headedness'.
Consider syncope – consider referral to Dr Deering, syncope clinic
Consider referral to Physiotherapy for hyperventilation
Dizziness is the commonest reason patients over the age of 75 see their GP. In the elderly there are usually multiple causes and the following should be considered:
Referral to a falls prevention programme may be appropriate.
Consider referral to Physiotherapy for Vestibular Rehabilitation or Hyperventilation (see below)
Consider referral to falls prevention programme for multi-system dizzy syndrome
Consider referral to ENT if:
Direct referrals can be made to your local Physiotherapy department to see a physiotherapist who works within Vestibular Rehabilitation. Hearing Therapy is a pathway for complex patients e.g. Meniere's, the Physiotherapists and ENT department refer direct to Hearing Therapy. This service is not directly available to GPs.
Patients can choose to access Vestibular Rehabilitation provided by Gloucestershire Hospitals NHS Foundation Trust at any of the sites listed below, either via GP letter referral - please email your referral document to email@example.com
self-referral using this online self-referral form:
In secondary or tertiary care, the following tests may be considered:
For Meniere’s disease, see vertigo pathway; ablative surgery or medical procedure may be considered: