Document resource
Training curricula and healthcare delivery should align with patients’ needs. Balance complaints are the second commonest complaint in general neurology clinics. That vestibular neurology is not core in the UK neurology training curriculum, serves our patients poorly. Why so? First ‘neuro-otology’ indicates an ear problem. However, most of the vestibular system is ‘central’, and the commonest diagnoses are brain-related. Second, few neurologists are exposed to tertiary vestibular neurology, so under-appreciate what is possible for balance patients. Diagnostic clarification for complex cases allows us to treat the treatable and leave alone the untreatable – simultaneously providing benefit and avoiding iatrogenic harm. In hyperacute vestibular syndromes, expert clinical assessment is diagnostically superior to DWI-MRI. But such expertise is acquired as an apprenticeship not realisable for most given the lack of centres, partly from the superficiality of the required vestibular competency. Vestibular neurology is enjoyable, hands-on and cross-cutting, with huge variety. From cerebellar ‘DBN’ syndromes, bilateral vestibular failure, neurodegeneration and falls, functional dizziness ‘PPPD’ (mostly iatrogenic in genesis), brainstem syndromes in MS/neuroinflammation with imbalance/eye-movement problems, complex TBI vestibular dysfunction with vestibular agnosia, to holistic balance assessments in elderly fallers. It’s time we match our training and skills to patients’ needs.bmseem@ic.ac.uk