Vestibular, ocular motor and balance assessment
Dizziness is a symptom with multiple potential mechanisms. Clarify timing, triggers, duration, hearing changes, headache, neurological symptoms, medicines and cardiovascular features before choosing a test. Brief position-triggered vertigo differs from continuous acute vestibular symptoms or chronic unsteadiness. A familiar maneuver is not appropriate simply because the patient uses the word dizzy. Safety and the possibility of a central or other serious cause come first.
The vestibulo-ocular reflex helps stabilize gaze during head movement. Saccades, smooth pursuit, vergence and fixation involve related but distinct networks. An abnormal eye movement may reflect a peripheral, central, visual, cognitive or medication-related problem depending on the pattern. A receded near point of convergence can prompt further assessment but does not independently establish every aspect of convergence insufficiency or its cause.
Benign positional vertigo is evaluated through the appropriate history and positional findings. The direction, timing and behavior of nystagmus matter, as does the person’s ability to tolerate positioning. Repositioning maneuvers are selected according to the canal and clinical assessment. A maneuver should not be improvised where medical, cervical or other restrictions make it unsafe. Persistent symptoms or atypical findings require reconsideration of the differential.
HINTS is not a general screening test for all dizziness. Its diagnostic use depends on the appropriate acute vestibular syndrome population and a clinician trained in performance and interpretation. Central or equivocal findings need the relevant emergency assessment. A normal head impulse in isolation does not rule out every peripheral condition or establish stroke in every person, and an abnormal impulse does not independently exclude stroke.
Rehabilitation can include appropriately selected gaze-stability, balance, habituation or substitution tasks when the diagnosis and safety context support them. Selection and progression depend on deficits, symptoms, vision, cognition and goals, not a fixed universal exercise sequence. Track meaningful function and avoid using symptom provocation as proof that a treatment is working. Written questions support interpretation but do not establish competence in eye-movement examination, positional maneuvers or distinguishing a stroke from a benign vestibular disorder.