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Management of the dizzy patient depends on history, bedside clinical examination, and laboratory testing. This chapter covers the first two portions of this evaluation. An accurate history is needed to determine the onset of the problem, description of the symptoms, and, most important, how the symptoms affect the individual's lifestyle. This last element is crucial to obtain because some individuals may have bedside clinical and laboratory evidence of chronic vestibular loss on one side but may be primarily affected by some other cause of dizziness, such as migraine or anxiety. The bedside clinical examination can be used to distinguish peripheral from central vestibular problems, the extent of loss, and how acute the problem may be. Laboratory testing (see Chapter 11) confirms the provisional diagnosis that was based on history and clinical findings, quantifies the degree of loss, provides evidence of central compensation, and shows evidence of an aphysiological component.


The history is by far the most important part of the evaluation. Unfortunately, taking a good history from the start can be extremely tedious, because the patient's complaints are often vague and also can be complicated by anxiety-provoked symptoms. For this reason, I divide the history into those elements that help with the diagnosis and those that lead to goals for management, including physical therapy.

Elements that Help with the Diagnosis

The tempo, symptoms, and circumstances of the patient's primary complaints are the three key items in the history (Table 10-1).


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