![]() The initial test is usually an MRI scan of the posterior fossa. If a central cause for the vertigo is suspected (e.g., no signs of peripheral vertigo, no hearing loss, no ear sensations, or the presence of other neurologic abnormalities indicating central nervous system disease), then prompt evaluation for central pathology is required. Rapid rotation in a swivel chair is a simple provocative test to reproduce vertigo.īenign positional vertigo is identified by the Dix-Hallpike maneuver to elicit vertigo and the characteristic nystagmus the pt begins in a sitting position with head turned 45° holding the back of the head, examiner gently lowers pt to supine position with head extended backward 20° and observes for nystagmus after 30 s the pt is raised to sitting position and after 1 min rest the maneuver is repeated on other side. Valsalva maneuver, hyperventilation, or postural changes leading to orthostasis may reproduce faintness. When the meaning of dizziness is uncertain, provocative tests to reproduce the symptoms may be helpful. 50) and vertigo (a sense of movement of the body or the environment, most often a feeling of spinning) is usually possible. With a careful history, distinguishing between faintness (presyncope Chap. The term dizziness is used by pts to describe a variety of sensations or gait unsteadiness. APPROACH TO THE PATIENT: Dizziness or Vertigo
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