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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Neurol Neurosurg Psychiatry. 2007 July; 78(7): 779.
PMCID: PMC2117671

Dizziness. A practical approach to diagnosis and management

Reviewed by Helen S Cohen

Adolfo Bronstein, Thomas Lempert. Published by Cambridge University Press, New York, 2006, pp 212. ISBN 0 521 83791 X

Vertigo is a common problem: the 1 year prevalence is more than 6%.1,2 Many of these people seek care from general medicine physicians rather than specialists and subspecialists. For many patients, rehabilitation, rather than medication or surgery, is the treatment of choice, and rehabilitation is better provided by occupational and physical therapists than physicians. Audiologists and nurses are also often involved in the diagnosis and care of these patients. A textbook on diagnosis and management of dizziness and balance disorders is needed for this diverse group of clinicians who are not specialty care physicians. This excellent textbook fills that need.

Chapter 1 is a good overview of the anatomy and physiology of the vestibular system. The science is explained clearly, with enough detail for concepts to be understandable, without overwhelming the reader. Chapter 2 discusses the clinical examination and objective diagnostic tests that are widely available. Vestibular evoked myogenic potentials and other recent laboratory tests are omitted, but those tests are still found primarily in academic medical centres and large specialty practices and may not be available in smaller specialty practices. The following chapters explain the common and uncommon causes of dizziness, how the definitive diagnosis is made and when to refer to specialty care. Tests for comorbid factors that can confuse the clinical picture are also explained. Chapters 3–6 discuss conditions that cause vertigo, including differentiation of some central neurological conditions. Chapter 7 addresses disequilibrium of aging, an important problem for all clinicians to understand. The authors support the use of a variety of treatment options, discussed in chapter 8, including medication, surgery, rehabilitation and counselling. The chapter provides an excellent overview of the range of care available and when to consider each option. Most chapters end with pragmatic advice about how to proceed when the diagnosis is not clear. The book is visually pleasing, with nice fonts and margins wide enough for note taking. Diagrams and tables are useful and easy to read.

The accompanying CD shows a physician performing a clinical examination and also shows the typical patient's responses. These videos should be quite useful for people learning to evaluate these patients. Using the demonstrated technique for the Dix–Hallpike manoeuvre may give the clinician back strain, so each clinician should adapt the test technique to his/her individual morphology. The few photographic images look grey and would be improved with increased contrast or arrows to direct the reader's eye. Exercises with the head stationary are probably ineffective, but the authors obviously appreciate the value of rehabilitation and the basic ideas are valid. Using the concepts illustrated, the reader should develop individualised exercises.

Minor problems aside, this text would be an excellent addition to any clinician's library. It would be useful for medical students and medical residents in neurology and otolaryngology, and non‐specialist physicians as well as therapists, nurses and audiologists.


1. Neuhauser H. Epidemiology of vertigo. Cur Opin Neurol 2007. 20 40–6
2. von Brevern M, Radtke A, Lezius F. et al Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007. 78 710–15

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