Evaluating the Dizzy Patient
Dizziness and imbalance are common presenting complaints to the neurologist. The lack of a systematic approach to the examination and laboratory evaluation of the vestibular system often leads to incorrect diagnoses and suboptimal care. With a basic understanding of vestibular physiology and proper examination techniques, a correct diagnosis can generally be made at the bedside. We review the principles of the neuro-otological examination, including assessment for static vestibular imbalance, dynamic vestibular function, provocative maneuvers, ocular motor examination, and vestibulospinal testing. The use of additional vestibular laboratory testing and neuroimaging is then considered to further localize and quantify abnormalities.
Objectives: Upon completion of this article, the reader will have a thorough understanding of the bedside examination and laboratory evaluation of the vestibular system.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the authors' relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the authors of this article.
The evaluation of the patient complaining of dizziness or imbalance is a challenging endeavor. A thorough understanding of the vestibular system, knowledge of specific examination techniques, and appropriate use of laboratory tests can greatly improve diagnostic accuracy and subsequent management. This article reviews the key elements of the bedside vestibular system examination and summarizes the utilization and interpretation of ancillary laboratory testing in vestibular patients. Basic physiologic principles of the vestibular system and important historical features to elicit when evaluating dizzy patients are discussed. The careful evaluation of eye movements is emphasized because of the close anatomic and physiologic connections between the vestibular and ocular motor systems.
Abstract and Introduction
Abstract
Dizziness and imbalance are common presenting complaints to the neurologist. The lack of a systematic approach to the examination and laboratory evaluation of the vestibular system often leads to incorrect diagnoses and suboptimal care. With a basic understanding of vestibular physiology and proper examination techniques, a correct diagnosis can generally be made at the bedside. We review the principles of the neuro-otological examination, including assessment for static vestibular imbalance, dynamic vestibular function, provocative maneuvers, ocular motor examination, and vestibulospinal testing. The use of additional vestibular laboratory testing and neuroimaging is then considered to further localize and quantify abnormalities.
Objectives: Upon completion of this article, the reader will have a thorough understanding of the bedside examination and laboratory evaluation of the vestibular system.
Accreditation: The Indiana University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit: The Indiana University School of Medicine designates this educational activity for a maximum of 1.0 hours in category one credit toward the AMA Physicians Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.
Disclosure: Statements have been obtained regarding the authors' relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the authors of this article.
Introduction
The evaluation of the patient complaining of dizziness or imbalance is a challenging endeavor. A thorough understanding of the vestibular system, knowledge of specific examination techniques, and appropriate use of laboratory tests can greatly improve diagnostic accuracy and subsequent management. This article reviews the key elements of the bedside vestibular system examination and summarizes the utilization and interpretation of ancillary laboratory testing in vestibular patients. Basic physiologic principles of the vestibular system and important historical features to elicit when evaluating dizzy patients are discussed. The careful evaluation of eye movements is emphasized because of the close anatomic and physiologic connections between the vestibular and ocular motor systems.
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