BACKGROUND: Vertigo and dizziness are among the most prevalent symptoms in neurologic disorders. Although many of these patients suffer from postural instability and gait disturbances, there is only limited data on their risk of falling. METHODS: We conducted a controlled cross-sectional study at the tertiary care outpatient clinic of the German Center for Vertigo and Balance Disorders using a self-administered questionnaire to assess falls, fall-related injuries, and fear of falling. The recruitment period was 6 months. RESULTS: A total of 569 patients (mean age 59.6 ± 17.1 years, 55% females) and 100 healthy participants were included (response rate > 90%). Dizzy patients with central balance disorders (Parkinsonian, cerebellar, and brainstem oculomotor syndromes) had the highest fall rates (> 50% recurrent fallers, odds ratio > 10). The rate of recurrent fallers was 30% in bilateral vestibular failure and peripheral neuropathy (odds ratio > 5). Patients with functional dizziness (somatoform or phobic vertigo) were concerned about falling but did not fall more often than healthy controls (odds ratio 0.87). CONCLUSION: Falls are common in patients presenting to a dizziness unit. Those with central syndromes are at risk of recurrent and injurious falling. Fall rates and fear of falling should be assessed in balance disorders and used to guide the regimen of rehabilitation therapy. The identification of risk factors would help provide protective measures to these groups of patients.

Gait disturbances are among the more common symptoms in the elderly. Reduced mobility markedly impairs quality of life, and the associated falls increase morbidity and mortality. Review of the literature based on a selective search (PubMed) on the terms "gait," "gait disorder," "locomotion," "elderly," "geriatric" and "ageing" (2000-11/2009) and the findings of the authors' own studies on gait changes in old age and on the functional brain imaging of gait control. Gait disturbances in the elderly are often of multifactorial origin. The relevant pathogenetic factors include sensory deficits (visual, vestibular, somatosensory), neurodegenerative processes (cortical, extrapyramidal motor, cerebellar), toxic factors (medications, alcohol), and anxiety (primary or concerning falls). A clinically oriented classification of gait disorders is proposed, which, on the basis of the characterization of gait and the accompanying clinical findings, enables identification of the etiological factors and points the way to rational therapy. Current research topics in the study of gait disturbances are also discussed, including quantitative gait analysis, interactions between locomotion and cognition (dual tasking), and functional imaging approaches. The evaluation of elderly patients whose chief complaint is a gait disturbance should be directed toward the identification of specific deficits. This is the prerequisite for rational therapy, even when the problem is of multifactorial origin. The preservation of mobility is important in itself, and also because the ability to walk is closely correlated with cognitive performance.

Vertigo and balance disorders are not uncommon in children. The prevalence of vestibular vertigo in 10-year-Dolds is estimated to be 5.7%. The most common cause is vestibular migraine which accounts for almost 40% of the diagnoses. In adolescents, the incidence of somatoform vertigo syndromes increases. Vestibular function can be reliably evaluated at the bedside by the head-impulse test for vestibulo-ocular reflex function, ocular motor testing of the central vestibular system, and balance tests for vestibulo-spinal function. Vestibular migraine is treated by behavioural and drug therapies. Somatoform vertigo improves if information about the disorder and behavioual advice are provided. Sometimes psychotherapy is useful; drug therapy is recommended in severe cases. Other common vestibular disorders in children include benign positioning nystagmus and labyrinthitis. In summary, the underlying causes of vertigo and dizziness in children can be diagnosed on the basis of patient history and clinical bedside testing. Reponses to caloric irrigation of the ears, rotational chair testing, posturography, and video-oculography can be used to ascertain the diagnosis. Brain imaging is indicated in patients presenting with subacute central vestibular signs. The majority of syndromes have a favourable prognosis and can be successfully treated.