Because of central adaptation, true vertigo is unlikely to be constant. Thus, constant symptoms are more likely to represent nonvertiginous dizziness and psychogenic complaints. A history of numerous chronic somatic complaints increases this possibility. When such a pattern emerges, it is prudent to obtain a psychiatric history and to ask about panic disorder and agoraphobia. However, the diagnosis of psychogenic symptomatology should only be entertained after other potential causes have been ruled out, and thus it is rarely if ever appropriate to entertain in the ED. Constant oscillopsia suggests a central neurologic diagnosis.
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