Clinical Decision-Making for a Patient with Dizziness, Ruling out Vertebrobasilar Insufficiency: A Case Study

Background: Dizziness is a nonspecific term that accounts for 5% of physician visits each year. The differential diagnosis of vertebrobasilar insufficiency (VBI) in patients with symptoms of vertigo and light-headedness is important and must be determined in a timely manner. The purpose of this case study is to go through the diagnostic process in determining if there is possible VBI involvement in a patient with complaints of dizziness. Case Description: The patient in this report is a 91-year-old female who was a referred to physical therapy by their primary physician for an evaluation for light-headedness and dizziness. The patient’s chief complaints during the initial examination were light-headedness, vision disturbances, and left neck and shoulder pain. Outcomes: The patient was examined and treated for cervicogenic dizziness for 4 visits over the course of 5 weeks. The Dizziness Handicap Inventory improved from 16 to 0 and cervical AROM returned to pain free and WFL. Discussion: This case report describes the importance of a thorough examination and determining differential diagnosis especially with patients who chief complaint is dizziness. There is need to make awareness to physical therapists to rule out causes that are potentially life threatening and refer to other healthcare providers as necessary