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November 2, 1994

Does This Dizzy Patient Have a Serious Form of Vertigo? Comment and Correction

Author Affiliations

Tucson, Ariz

JAMA. 1994;272(17):1324. doi:10.1001/jama.1994.03520170033018

To the Editor.  —The Rational Clinical Examination article on the dizzy patient by Dr Froehling and colleagues1 puts forth at least two ideas that were not rational.First, they recommended that we inquire from our patients at what time of day their dizziness occurs because "matutinal vertigo... is usually due to a peripheral vestibular disorder." They later directly contradicted that advice by stating that matutinal vertigo cannot distinguish very well peripheral from central causes. They cite references (their number 202 and number 403) for both arguments.Second, their Table 3 tries to segregate patients into either of two groups, serious or nonserious, on the basis of three criteria (vertigo, age of 69 years or less, and absence of neurological deficits). A patient would qualify for one group if he or she manifested one or more of the three criteria, and he or she would qualify for the

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