How should dizziness with focal neurological signs be managed in physical therapy?

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Dizziness with focal neurological signs points to possible central or vertebrobasilar pathology, such as stroke or brainstem/cerebellar involvement, rather than a benign vestibular issue. In physical therapy practice, this triggers an urgent safety screen: if such red flags are present, you must halt the musculoskeletal assessment and refer immediately for medical evaluation. Delaying evaluation in the face of focal neuro signs can miss a life-threatening condition and lead to worse outcomes, so the appropriate action is urgent medical referral rather than continuing with PT testing or treatment.

This differs from handling benign dizziness or musculoskeletal pain, where a PT exam can proceed with appropriate screens. Proceeding with a musculoskeletal workup while monitoring symptoms fails to address the critical risk, and waiting for significant musculoskeletal pain or giving home exercises with a two-week reassessment ignores the potential for acute CNS pathology.