Vertigo And Balance Problems; Screening For Appropriate Referral
by: Dr. A. R. Scopelliti
With complaints of dizziness, vertigo or disequilibrium, symptoms can be the result of vestibular, neurologic, vascular, psychologic and even orthopedic pathology. As such, it is not always clear which specialty is appropriate for referral.
In this age of cost awareness and effectiveness, the primary care physician must make important decisions as to the appropriateness and cost-effectiveness of diagnostic procedures and referrals to specialists. Patient's complaining of dizziness or disequilibrium without obvious objective signs, for lack of a more specific diagnostic direction, are often referred for MRI/CAT scan imaging studies to rule out the possibility of brain lesions. The cost effectiveness of this decision deserves scrutiny, as the yield of these studies is very low whereas the diagnostic yield of appropriate physical examination in the doctor’s office is very high.
"Balance disorders are common, while brain tumors are rare". Prior to the commencement of tests such as MRI, points that need consideration are the likelihood that MRI will provide any relevant diagnostic information and whether the sensitivity of less expensive more diagnostically useful tests can be performed first.
In our office, the goal of the initial office examination is to determine the probable cause of the patient's symptoms. A directed history and extensive neurologic physical examination allows for more exacting diagnosis and thus successful treatment. Unfortunately, in this day of managed care, many providers must succumb to time constraints prohibiting extensive examinations, necessitating referrals to specialists.
Currently, 50% of patients seen in the primary care setting receive no diagnosis for their complaints of dizziness, yet 70% receive a prescription for meclizine, (Antivert). Meclizine has not been demonstrated to be effective or appropriate in the treatment of chronic disequilibrium, dizziness or imbalance. It is occasionally effective in reducing nausea associated with vertigo/spinning in some forms of chronic vertiginous disease, however, it is not curative in any way, and in fact interferes with the natural recovery process often worsening matters further. It is appropriate to state at this time, that you do not need a specialist referral to consult with me in my office.
Dr. Scopelliti is a Fellow of the American College of Functional Neurology and a Fellow of the American Board of Vestibular Rehabilitation. He is currently president of NJCCN. His practice is located at the 279 Medical Arts Bldg at Monmouth Medical Center, in Long Branch, NJ. His office focuses on the drug free management of patients with vertigo, dizziness, imbalance, presyncope, dystonia, ADD ADHD, various stages of coma, and other neurologic as well as behavioral/cognitive disorders. Dr. Scopelliti has also authored several Lectures and Software for Neurologic and Vestibular Rehabilitation. Dr. Scopelliti has a wealth of information updated weekly on the web at Jersey Shore Regional Center For Vertigo, Dizziness, Dystonia and ADD ADHD. Visit Dr. Scopelliti’s Guestbook to see what real patients have had to say.
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