Dizziness and balance problems can arise from a wide range of conditions, including inner-ear disorders, migraine, stroke, neurological injury and complications of medical treatment. Identifying the underlying cause can be particularly important in clinical negligence and personal injury cases, where diagnosis, causation and long-term disability may be in question.
In October 2026, NRC Medical Experts hosted a free webinar for solicitors, case managers and rehabilitation professionals with Consultant in Neurology and Stroke Medicine Dr Richard Ibitoye.
Using clinical examples, Dr Ibitoye examined the differential diagnosis of dizziness and vestibular disorders, the role of clinical examination and testing, and medico-legal considerations including missed posterior circulation stroke, vestibular injury following trauma and antibiotic-related balance problems.
Focus of the session
The webinar examined how the vestibular system supports balance, eye movements and our perception of movement and position. Dr Ibitoye explained how problems affecting this system can cause vertigo, unsteadiness, nausea and other symptoms that may significantly affect daily life.
He discussed the clinical approach to assessing dizziness, including the importance of symptom history, onset, duration, triggers and examination findings. The session covered eye movement assessment, positional testing, the head impulse test and specialist vestibular investigations.
Through three clinical case examples, Dr Ibitoye examined common vestibular conditions, including benign paroxysmal positional vertigo (BPPV), vestibular neuritis and vestibular migraine, explaining how different presentations and examination findings inform diagnosis.
A particular focus was the risk of missed posterior circulation stroke in patients presenting with acute severe dizziness. Dr Ibitoye considered clinical warning signs, and common diagnostic errors, including reliance on a normal initial CT scan.
The session concluded with medico-legal considerations surrounding vestibular problems following traumatic brain injury or severe illness, with particular attention to gentamicin-induced vestibulotoxicity.
Gentamicin is an intravenous antibiotic used to treat serious bacterial infections, but it can cause permanent damage to the vestibular system in the inner ear, resulting in long-term balance problems. Patients may experience persistent unsteadiness, difficulty walking and an increased risk of falls and related injuries. These symptoms can be overlooked during recovery from serious illness, meaning gentamicin-induced vestibular damage may not be diagnosed until much later.
Dr Ibitoye examined the implications for clinical negligence and personal injury cases, including the challenges of recognising antibiotic-related vestibular dysfunction, establishing causation and assessing its long-term impact on mobility, independence and rehabilitation needs. Older patients with pre-existing balance difficulties may be particularly vulnerable to poor outcomes.
📺 Watch the webinar – below and on YouTube
Key learning points
The webinar covered:
- The role of the vestibular system in balance, eye movements and perception of movement.
- Common causes of dizziness, vertigo and unsteadiness, including BPPV, vestibular neuritis and vestibular migraine.
- The importance of symptom history, clinical examination and vestibular testing in reaching an accurate diagnosis.
- How clinical findings can help distinguish peripheral vestibular disorders from central neurological causes.
- The risk of missed posterior circulation stroke, including diagnostic pitfalls in patients presenting with acute severe dizziness.
- The role of the HINTS+ examination in assessing appropriate acute presentations.
- Vestibular disorders following traumatic brain injury, including BPPV and unilateral or bilateral vestibular dysfunction.
- Gentamicin-induced vestibular damage and its potential long-term effects on balance, mobility and falls risk.
- Medico-legal considerations relating to missed diagnoses, complications of treatment and persistent vestibular symptoms.
Accurate diagnosis is particularly relevant when considering whether symptoms are attributable to an injury, underlying condition or medical treatment.
For legal professionals, these distinctions may affect questions of breach of duty, causation, prognosis and the assessment of ongoing care and rehabilitation needs.
Instruct Dr Richard Ibitoye
Dr Richard Ibitoye is a Consultant in Neurology and Stroke Medicine at North Bristol NHS Trust and an expert witness with NRC Medical Experts.
His clinical and medico-legal practice covers dizziness and balance disorders, vestibular dysfunction, stroke, cerebral small vessel disease and complex neurological presentations.
Dr Ibitoye studied medicine at the University of Cambridge and completed his neurology training in the Severn Deanery. His PhD research at Imperial College London examined chronic dizziness in older people and its links with cerebral small vessel disease. He received the Hallpike Prize for his vestibular research and completed a Guarantors of Brain Postdoctoral Fellowship examining the effects of small vessel disease on balance.
For expert witness opinion in cases involving dizziness, balance disorders, stroke or complex neurological conditions, contact NRC Medical Experts to discuss instructing Dr Ibitoye.
View Dr Richard Ibitoye’s expert witness profile
Contact NRC Medical Experts
enquiries@nnrc.org.uk
0191 466 1406
