Anamnesis an Clinical Evaluation of Whiplash-Associated Equilibrium Disturbances (WAED)

In all medical fields a good case history evaluation is the key of a correct diagnostic pathway. Patients’ complaints have to be documented as completely as possible just from the beginning of the disease. Sometimes the examiner uses technical terms to question the patient, and this can lead to confusion and misunderstandings. The first diagnostic task is to differentiate between vertigo and dizziness or disequilibrium, ruling out the many varieties of indistinct dizziness such as faintness. Vertigo is linked with a spinning sensation around the head and frequently a vestibular disorder. Vertigo is the awareness of some dysfunction in the balance mechanisms, that is, a dysfunction in the balance mechanisms becomes a conscious experience. The sensation is characterized by feelings of “spatial disorientation”, whereof the illusion of false movement is the most characteristic. “Rotatory sensation” is the most typical sensation, but it is not the sole feeling generated by balance dysfunction. The basic impression has to be the sensation of loss of stable subjective relationship with the environment. In this way less typical sensations must be included and are called “atypical” vertigo. On the other hand, syncopes, blackout, drop attacks, odd sensations in the head, etc., have to be denied as primary “vertigo” sensations, but they can accompany true vertigo. Dizziness or a turning sensation inside the head may result from disturbances of integrating structures within the central nervous system. Atypical dizziness is usually confused with disequilibrium. The term “dizziness” is used popularly. It includes a multitude of symptoms related to the vestibular system or other aspects of the nervous system. Dizziness is applied to physical, emotional or intellectual disturbances, whose common denominator seems to be a loss of stability, a disruption of the pattern in which the individual is aware of his surroundings and their relation to him, whether these refer to his physical orientation in space, his emotional equilibrium or his intellectual clarity. It is important that the patient describes symptoms with his/her own words in the simplest way. In this sense Grateu [1] proposed a simplified chart to investigate vertigo and dizziness during common or less common daily activities (Fig. 15.1) every time the examiner has to lead the patient in order to identify the main elements of patient history.