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Differential diagnosis in a patient with dizziness.

The patient was a 54-year-old woman with a 5-month history of worsening dizziness with head movements. She also complained of mild coordination problems and intermittent numbness and tingling in both upper extremities. Magnetic resonance imaging of the brain and orbits ordered by the patient's neurologist revealed a left orbital mass thought to represent a benign optic nerve sheath meningioma. Management included close monitoring of the patient's vision by the neurologist and referral to a physical therapist. On observation, the patient demonstrated a slowed gait and an inability to tandem walk. Range-of-motion assessment of the cervical spine revealed full pain-free motion. Although no visual deficits were noted, the patient complained of dizziness with eye movements. Manual muscle testing revealed weakness with testing of right shoulder abduction, right elbow flexion and extension, and bilateral hip flexion and knee extension. Because of the strong suspicion of spinal cord involvement, the physical ther...