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You should read this book if you are dizzy, if you are lightheaded, if your world seems to move when it ­ shouldn’t, or if you are off balance and have fallen. The authors of this book specialize in taking care of ­ people with dizziness and imbalance and they understand how distressing ­ these symptoms can be. (Words appearing in boldface type are defined in the glossary at the back of the book.)­ People with dizziness tell us we are their “last hope.” We believe that’s an overstatement, but it captures the way many dizzy ­ people feel. The good news is ­ there are always ­ things we can do for ­ people with dizziness. This untapped therapeutic potential is what gets us into the clinic on days we see patients. Our clinics and ­ those like them go by a variety of names. Sometimes our specialty is called otoneurology (a term that is used a lot in Boston) or neuro-­ otology (a hyphenated term that has been sanctioned by the American Acad­ emy of Neurology), or neurotology (used at the University of California at Los Angeles , though not without slight confusion ­ because ­ there is also a surgical specialty called neurotology, which is a branch of otolaryngology). What­ ever you call it, our specialty involves Preface Preface x making a diagnosis and prescribing treatment for ­ people with dizziness and imbalance. Most ­ people with dizziness ­ will be treated first by a generalist , such as a doctor trained in internal medicine, ­ family practice, or emergency medicine. In many cases, the generalist ’s approaches work well. But many generalists go only so far with dizziness. They have a few reasonable responses to dizziness in their toolbox. When ­ these do not work, many refer dizzy ­ people to clinics like ours, at least in regions of the country where such clinics exist. We hope this book ­ will fill a need for ­ people who do not have access to a dizziness specialist and enhance care for ­ those who do have such access. In this book, we start from the assumption that the reader would like to know how the best doctors make a diagnosis. We base this assumption on our experience with many thousands of patients. Many ­ people with dizziness have seen multiple doctors, and none of ­ these doctors has been able to make a clear diagnosis. The reader may have nothing to go on, other than his or her symptoms. Therefore, we focus on symptoms. We have divided the book into parts, each of which addresses a par­ tic­ u­ lar class of symptoms. Within each such part, we discuss specific diseases: how they are defined and diagnosed, how doctors and scientists understand the disease, and the best approaches to treatment. Childhood dizziness could be the focus of a ­ whole book and as such is beyond the scope of the pres­ ent volume, though many of our comments are applicable to ­ children as well as adults. How did we decide which diseases to include? We admit that this was a challenge. We apologize in advance to ­ those for whom we have omitted something impor­ tant. An essential prob­ lem is that almost ­ every disease can cause dizziness. We must always therefore be on the alert for a serious disease presenting as “dizziness.” Some examples are stroke, transient Preface xi ischemic attacks (TIAs), multiple sclerosis, and brain tumors. The doctor who cares for ­ people with dizziness must have a solid grasp of general medicine. Despite this array of possibilities , though, the vast majority of ­ people who come to our dizziness clinics have something not so serious, though even a short-­ lived prob­ lem can make the affected person feel very sick for a period of time. Medical students are taught to concentrate on the common ­ causes of symptoms. The focus on the common is encapsulated by the old saying that when one hears hoofbeats, it is best to think of ­ horses, not of zebras. We ­ will tell you about the most common prob­ lems experienced by our patients. In addition , we ­ will identify so-­ called red flags—­ symptoms that suggest the possibility that something more serious is ­ going on. We also give the reader some ideas about how we recognize that we are dealing with a less common disorder—­ a zebra and not a ­ horse. With re­ spect to the common, one might ask: why focus on our own clinics at UCLA-­and Harvard-­ affiliated hospitals?­ Isn’t that asking for bias? Do our clinics reflect the experience of ­ people...


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