Brain & Nervous System Neurological Symptoms & Diagnosis Print Symptoms and Causes of Chronic Subjective Dizziness Medically reviewed by Medically reviewed by Claudia Chaves, MD on November 03, 2019 Claudia Chaves, MD is board-certified in cerebrovascular disease and neurology, with a subspecialty certification in vascular neurology. Learn about our Medical Review Board Claudia Chaves, MD Written by Written by Peter Pressman, MD Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders. Learn about our editorial policy Peter Pressman, MD Updated on November 22, 2019 Daniel Borg / Getty Images More in Brain & Nervous System Neurological Symptoms & Diagnosis Autism Headaches Multiple Sclerosis Parkinson's Disease Stroke Alzheimer's Down Syndrome Epilepsy Migraines Head Trauma More Neurological Diseases Treatment View All The term chronic subjective dizziness (CSD) is used to describe a commonly encountered type of dizziness that is not easily categorized into one of several other types, and for which the physical examination is typically normal. Overview Patients with CSD frequently initially suffer a sudden injury of some sort to their vestibular system, which is the neurologic network that preserves our sense of balance. Even after this initial injury has healed, people with CSD usually describe a vague sense of unsteadiness worsened by triggers in their environment. These triggers may include high places, standing on moving objects, or standing in motion-rich environments, like busy streets or crowds. Symptoms While formal diagnostic criteria for CSD are still being established, common symptoms include the following: A sense of unsteadiness that is constantly present, though the severity may fluctuateDisequilibrium is present for most days over at least a 3 month period Symptoms are most severe when walking or standing, and usually absent or very minor when laying still.Symptoms are worsened by motion, exposure to moving visual stimuli, or performing precise visual activities. The disorder usually comes on after an acute disorder that disrupts the vestibular system. Also, it occurs in the presence of acute or recurrent medical and/or psychiatric problems such as minor depression, anxiety, or obsessive/compulsive traits. Causes The exact cause of chronic subjective dizziness is still being worked out. The general theory, however, is that the disorder results from the brain’s inability to readjust after the vestibular system has been damaged. The inner ears connect to the vestibulocochlear nerve, which sends signals to the vestibular nuclei in the brainstem. These nuclei work with other areas of the brain to integrate information about posture and motion with other sensory information such as vision. When the vestibular system says one thing, like “we’re moving,” and the other systems say, “no, we’re not,” dizziness is a common result. The inner ears normally balance each other out. For example, if you turn your head to the right, one vestibulocochlear nerve is more active than the other, and the brain interprets the difference in signal power as a head turn. So what happens if the signal from one ear is dampened by something else, like an infection? The vestibular nuclei send information to the rest of the brain that the head is turning, even if in reality the person is standing still. Brains are usually very adaptable and can learn to adjust to changes in neural signals. Just like your eyes adjust to being in a darker room or your ears get used to a constant background hum, the brain usually works around a vestibular deficit in order to establish a new working model of the world. After damage is done to the vestibular nerve, the imbalanced electrical signals are eventually understood to be the new normal, and life goes on. In CSD, the brain fails to adjust to a new normal. Even though the original insult may have healed, the brain remains hyper-vigilant to anything that has to do with motion or balance, like a soldier who, home from war, still jumps or ducks for cover every time a car backfires. In addition, underlying personality traits or psychiatric disorders may contribute to this inability to correctly estimate movement. Perhaps a shared underlying mechanism, such as a relative deficit in a particular neurotransmitter, causes both the personality trait and the sense of imbalance. Prevalence CSD is still gaining recognition within the medical community, and so the exact prevalence is uncertain. That said, in academic centers where the disorder is recognized, it's among the most common causes of dizziness in people who go to those centers. This means that other, better-recognized causes have usually been excluded by other doctors prior to making the referral. What to Do If You Think You Have CSD If you haven’t already, talk to your doctor about the diagnosis. While not all physicians may recognize the disorder, most will be happy to look into it or at least make a referral. It's important you do speak with a medical professional, however, since there are treatments available for CSD. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Staab JP. Chronic subjective dizziness. Continuum (Minneap Minn). 2012 Oct;18(5 Neuro-otology):1118-41. JP Staab, DE Rohe, SD Eggers, NT Shepard. Anxious, introverted personality traits in patients with chronic subjective dizziness. J Psychosom Res. 2014 Jan;76(1):80-3. Continue Reading