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  • Demographic Information:

    Patient is a 65-year-old woman who presents for evaluation and treatment owing to complaints of dizziness that began 4 to 6 weeks ago. She is ambidextrous and wears glasses and contact lenses.

  • Employment, Living Environment, and Social History:

    Patient is a retired high school guidance counselor but works as part-time summer help in a perennial garden nursery. She lives alone but has a busy social life and travels frequently.

  • Medical History:

    She states she is in excellent health but has a history of cervical and lumbar arthritis, thyroid disease, high blood pressure, and elevated cholesterol levels. She also reveals that she had a lumpectomy more than 30 years ago for a benign tumor and underwent surgery for trigger finger (stenosing tenosynovitis) 3 years ago. She reports a “bout of viral meningitis” over 20 years ago and experienced an isolated episode of atrial fibrillation approximately 1 year ago. She is scheduled for left foot neuroma removal surgery in 2 weeks. She exercises four or five times per week for 20 to 60 minutes and enjoys walking and going to the gym.

  • Current Condition/Chief Complaints:

    Patient reports that when she awoke dizzy one morning 4 to 6 weeks ago, she experienced nausea and difficulty walking that lasted for a few days. She went to her primary care physician, who put her on meclizine for 10 days. She notes gradual improvement in her symptoms and describes her current condition as “stable.” She denies falling. She states that, at this time, looking up and turning to the right continues to cause increased symptoms. She experiences occasional spinning dizziness with quick head movements and states that sometimes she does not spin but also does not feel normal. She states she frequently feels off balance. She denies tinnitus, hearing loss, or fullness or pressure in her ears.

Systems Review: Musculoskeletal System

No formal examination was performed given the nature of the patient’s complaints and lack of observable physical impairments.

Tests and Measures

  • Rating of Symptom Severity:

    • At the start of today’s examination, the patient rated her symptoms as a “1 to 2” on a scale of 0 to 10.

  • Dizziness Handicap Index:

    • Her score on the Dizziness Handicap Index (DHI)1 is a 26 on a scale of 0 to 100.

  • Balance and Visual Testing:

    • Modified Clinical Test for Sensory Integration in Balance (mCTSIB)2: Results from the mCTSIB are presented in Table CS9.1.

    • Walking with quick head turns to left and right: When performing this activity, the patient demonstrates minor disruption in gait.

    • Oculomotor testing in room light: The patient’s gaze and nystagmus are normal in room light. She was able to perform smooth pursuits in horizontal, vertical, and diagonal planes without interruption. Tests for saccadic control in the horizontal and vertical planes were also normal but more difficult to ...

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