Learning, teaching and sharing knowledge is the most evolved human activity and is regarded as the source of ultimate pleasure. One of the most efficient means of learning and teaching is through storytelling and this had been extensively used in ancient Indian teachings. Case discussion is also a form of storytelling. The importance of case reports, however, has gone down in modern medical journals. Vertigo is a common neurological problem but does not get adequate attention in undergraduate and postgraduate training programs. The patients with vertigo, often shuffle between neurologist, ENT surgeon, neurosurgeon, psychiatrist and physician; as happens with many other disorders with overlapping symptoms.

This book is primarily meant for practicing neurologists and neurology trainees. Vertigo and dizziness are extremely common symptoms. More than 10% of all patients attending neurological outpatients department of any major teaching hospital in the country, present with vertigo and dizziness. Approximately half of these subjects have vestibular disorders, about a quarter are of psychogenic in origin and the rest is constituted by neurological and mixed disorders. Truly speaking, the assessment and management of most of these patients are often far from adequate and appropriate. The fault in reality lies in our training program wherein very little attention is given to the aforementioned two issues. There are probably a child's handful of neurologists in the country who take active interest in the management of such patients. The referral perspectives of physicians at large is also perhaps far from ideal. The fact that the principal end organ responsible for disordered balance and the genesis of vertiginous symptoms lies in the inner ear, make both general physicians and lay public think that patients with vertigo and dizziness should ideally be seen by ENT specialists at least initially. This view is shared by many neurologists as well-resulting in many such patients attending a neurological OPD being referred to the ENT specialists. This may be viewed as a point of debate. Physiologically speaking, vertigo results from either a sensory mismatch between various balance concerned afferents (including those coming from the labyrinth) or from a CNS misinterpretation of the information gathered. Both of these occur in the brain. The first in the vestibular nuclear level situated in the brainstem and the second at various levels of the CNS right up to the cortex. So, the problem is essentially a neurological one. Most cases of vertigo, if proper diagnosis can be made, can be treated medically and through physical means. A small minority needs surgical interventions. Hence it is essential for neurologists to be well conversant with these disorders, their diagnosis and management. Testing vestibular functions have been revolutionized in recent times and some ENT specialists have acquired special skills to perform and interpret these. Neurologists need to be acquainted with the principles of such tests, which nowadays are generally computer based. However, for correct diagnosis and management of patients with vertigo, the test results need to be properly correlated with clinical history and physical findings. It is only neurologists who are properly trained to acquire that skill. The sole purpose of this book is to get more and more neurologists interested in the discipline of neuro-otology for proper management of patients with vertigo and balance disorders.