Continuous dizziness and an inappropriate reassurance

A patient develops continuous severe dizziness, nausea and difficulty walking. The patient has nystagmus and describes the symptoms as unlike previous brief positional episodes. A practitioner who has watched an online eye-movement video wants to perform a few rapid head movements and declare the condition benign if one response seems reassuring. The presentation and the practitioner’s level of training do not justify that shortcut. The history also includes vascular risk factors, although no single risk factor establishes the cause. The appropriate response must consider the complete acute syndrome, current neurological findings and access to emergency assessment. A bedside technique should not delay referral or be used outside the population and expertise for which its interpretation is supported.