Vertigo

I would like to congratulate Kevin Barraclough and Adolfo Bronstein on their excellent coverage of vertigo as a presenting symptom to a general practitioner. The article was lucid and practical and contained the evidence that will enable early accurate diagnosis of what can be a most disturbing symptom. It would have been nice to see a little more about management strategies that could be instituted in a GPs surgery, but perhaps I am pre-empting the next paper from Prof. Bronstein. I would, however, like to point out that this article only applies to adult patients. Children complaining of unsteadiness, dizziness or vertigo present with entirely different pathologies.

For example, benign paroxysmal positional vertigo (BPPV), which is common in adults, is very rarely seen in children and then only with a history of preceding head trauma of some significance, while migrainous vertigo and its equivalent, benign paroxysmal vertigo of childhood (BPVC) (not to be confused with BPPV), are relatively common causes of recurrent vertigo. On the other hand, a history of recent unsteadiness in a child may herald an intracranial tumour, while child abuse and visual difficulties can both present as dizziness. The diagnostic list for children is no less exhaustive than for adults, but it is different.

Furthermore, obtaining a relevant history from a child and performing a neuro-otological assessment in order to differentiate one cause from another requires not inconsiderable expertise.

The child’s presentation and the diagnostic pathway for dizziness in children are different from adults. Therefore, while I applaud the excellent diagnostic pathway outlined in this paper, I would ask that it be made very clear that it is for adults only

Competing interests: None declared