Dizziness. A clinical perspective

The clinical history and examination of dizzy patients leave much to be desired. Nevertheless, they are vital, as the selected treatment may be inappropriate and test data are likely to be meaningless unless interpreted in light of a thoughtful history and physical. Despite enormous variability in symptoms and signs of dizziness, the clinician must strive to categorize the patient's problems according to localization and etiology. The rules of thumb outlined above may assist in that enterprise. The remainder of this issue includes discussion of several sophisticated diagnostic tests aimed at understanding the nature of dizziness. Some of them are well established and some are investigational. Even with such a diagnostic battery, dizziness remains a perplexing problem. The complexity of the vestibular system and its interactions with visual input, somatosensory input, motor response, and conscious awareness continue to challenge our technology and our clinical acumen.