Episode Summary
Learn how clinicians assess dizziness by separating harmless peripheral causes from urgent central conditions, using key clues from history, symptoms, eye movements, and balance testing. Discover the practical thought process that guides referral, diagnosis, and targeted rehabilitation.
Assessment of dizziness is presented as a dual process: identifying the likely diagnosis while also observing functional problems and symptom triggers. The first priority is distinguishing peripheral from central causes, because central signs may require urgent referral, imaging, or hospital assessment, while peripheral conditions are often managed directly. Common peripheral causes include BPPV, vestibular neuritis, Ménière’s disease, and unilateral vestibular loss; central causes include stroke, vestibular migraine, cerebellar disorders, and sensory integration problems.
A second framework classifies dizziness as acute, recurrent, or chronic continuous, which helps narrow likely pathology and guide prognosis. Strong emphasis is placed on history taking, aggravating factors, previous successful treatments, red flags, hearing loss, cervical trauma, and vascular risk factors.
The assessment then focuses on screening for central nervous system involvement through cerebellar testing, cranial nerve and ocular motor examination, smooth pursuit, vestibular suppression, saccades, optokinetic testing, and the HINTS exam for acute dizziness. Head tilt and skew deviation are also used to separate peripheral from central problems. Learners can expect a practical clinical approach that links examination findings directly to referral decisions and rehabilitation planning.
