PracticeUpdateMy Approach to Managing the Dizzy Patient at a Center of Balance

The patient, a 45-year-old female, presented with symptoms of dizziness, eyestrain, and nausea, particularly when reading or scrolling on screens. These symptoms began after a motor vehicle accident.

In the complex world of diagnosing and treating dizziness, an interdisciplinary approach can be key to successful patient outcomes. This case study illustrates the value of such an approach, particularly highlighting the role of the neuro-optometrist in managing a patient with post-concussion syndrome and visual-vestibular dysfunction.

Key Points:

• Dizziness is a common symptom post concussion and can be caused by disruptions to the visual, vestibular, or somatosensory systems.
• The patient was diagnosed with convergence insufficiency, deficit of pursuits and saccadic eye movements, visual-vestibular dysfunction, visual-motion sensitivity, hyperopia with presbyopia, and post-concussion syndrome.
• Treatment involved a comprehensive rehabilitative plan, including neuro-optometric rehabilitation therapy (NORT), prescription glasses with specific modifications, and a gradual progression of exercises to improve visual-vestibular processing and balance.

Additional Points:

• The patient’s treatment plan was individualized, starting with enhancing accuracy and awareness of fixation, pursuit, and saccade, and gradually integrating more complex multisensory information processing.
• After approximately 5 months of NORT, the patient reported significant improvement in her symptoms of dizziness, eyestrain, and instability when walking.
• The patient’s final prescription included updated spectacle progressive addition lenses (PALs) with E-15 blue tint, which she was able to tolerate due to improvements in her binocular vision.

Conclusion:

• An interprofessional approach, particularly involving a neuro-optometrist, can be highly effective in managing patients with dizziness and disequilibrium, especially when these symptoms are exacerbated by head movement and peripheral motion with underlying binocular vision dysfunctions.

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Did You Know?
Dizziness is the second most frequently reported symptom post-concussion.