Circumstances surrounding the onset of the symptoms: Are the symptoms occurring in a spontaneous manner or are the symptoms provoked by head or visual movement, visual complexity, or visual patterns?.Temporal course of the symptoms: If the symptoms are paroxysmal, would the typical duration be measured in seconds, minutes, hours, or days, and what is the range from the shortest to longest? If continuous, are there exacerbations in the intensity of the symptoms, and what is the duration of those exacerbations?.Therefore, in extracting the history of the presenting and past symptoms there are four areas of information that play a major role in helping to provide a first-pass judgment as to whether the symptoms would be most likely of peripheral or central origin. The term dizziness is a general term that can encompass imbalance, lightheadedness, objective vertigo (objects in the room appear to move) and subjective vertigo (the sensation of spinning is within the patient's head, objects in the environment are stationary), or combinations of the above. Recognize that the most common term used by a patient is that of dizziness. To make use of the presenting symptoms, the examining audiologist needs details of the symptoms. The symptoms being reported by the patient can be very useful as a first filter to narrow etiologic possibilities and serve as a framework for interpretation of the findings from the formal laboratory or by means of direct office examinations. It is the purpose of this article to review the signs and symptoms associated with dizziness that would more likely be of central vestibular origin. However, just as a significant caloric asymmetry would be taken as an indication of peripheral dysfunction, the abnormal central findings on vestibular laboratory testing need to fit with the symptom presentation to suggest that those findings relate to the patient's presenting complaints. In most cases well-defined abnormalities on pursuit tracking or with saccade testing are indicators of central vestibular system involvement. Over the years, one of the principal uses of vestibular function evaluations, both direct examination and laboratory studies, has been to differentiate between peripheral and central vestibular system disorders.
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