Dizziness physical examination

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Physical Examination

Physical examination of patients includes reproducing dizziness in the clinic by following these maneuvers[1][2][3][4][5]:

  • Dix-Hallpike maneuver- Turning the patient's head at 45 degrees to one side, and rapidly laying the patient into a supine position with the head hanging about 20 degrees over the end of the table, any abnormal eye movement within 30 seconds indicates vestibular debris.
  • Orthostatic blood pressure measurement- Drop-in blood pressure from supine to standing position indicates orthostatic hypotension.
  • Romberg test- Swaying or leaning towards one side is indicative of ipsilateral vestibular dysfunction.
  • Observation of gait- To look for any symptoms of parkinsonism disease such as small steps and less arm swing.

References

  1. McGee S, Abernethy WB, Simel DL (1999). "The rational clinical examination. Is this patient hypovolemic?". JAMA. 281 (11): 1022–9. doi:10.1001/jama.281.11.1022. PMID 10086438.
  2. Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA (1996). "Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study". BMJ. 313 (7060): 788–92. doi:10.1136/bmj.313.7060.788. PMC 2352174. PMID 8842072.
  3. Goebel JA (2001). "The ten-minute examination of the dizzy patient". Semin Neurol. 21 (4): 391–8. doi:10.1055/s-2001-19410. PMID 11774054.
  4. Kroenke K, Lucas CA, Rosenberg ML, Scherokman B, Herbers JE, Wehrle PA; et al. (1992). "Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care". Ann Intern Med. 117 (11): 898–904. doi:10.7326/0003-4819-117-11-898. PMID 1443950.
  5. Ebersbach G, Sojer M, Valldeoriola F, Wissel J, Müller J, Tolosa E; et al. (1999). "Comparative analysis of gait in Parkinson's disease, cerebellar ataxia and subcortical arteriosclerotic encephalopathy". Brain. 122 ( Pt 7): 1349–55. doi:10.1093/brain/122.7.1349. PMID 10388800.

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