What should be included in the physical exam of dizziness, vertigo, and imbalance?

Updated: Mar 13, 2017
  • Author: Hesham M Samy, MD, PhD; Chief Editor: Robert A Egan, MD  more...
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In patients with dizziness, the general examination should emphasize assessment of vital signs, supine and standing blood-pressure measurements, and evaluation of the cardiovascular and neurologic systems. Examine the ears for visible infection or inflammation of the external or middle ear. Test hearing and discrimination by using a tuning fork and by whispering and asking the patient to repeat heard words. Examine the neck for range of motion and flexibility.

Focused neurologic examination of the cranial nerves, motor and sensory modalities, gait, and stance is important in the initial visit. Cerebellar tests, especially failure of fixation suppression (FFS) of vestibular eye movements, are important for checking the vestibulocerebellum. Failure of fixation suppression (FFS) can be tested by asking the patient to stretch his arms and look at his thumb while being passively rotated (manual rotation of examination chair). A visible nystagmus (right or left) indicates FFS that is always central in origin.

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