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Clinical features of common causes of vertigo*

Clinical features of common causes of vertigo*
  Time course Suggestive clinical setting Characteristics of nystagmus Associated neurologic symptoms Auditory symptoms Other diagnostic features
Benign paroxysmal positional vertigo Recurrent, brief (seconds) Predictable head movements or positions precipitate symptoms Peripheral characteristics None None Dix-Hallpike maneuver shows characteristic findings
Vestibular neuritis Single episode, acute onset, lasts days Viral syndrome may accompany or precede vertigo Peripheral characteristics Falls toward side of lesion, no brainstem symptoms Usually none Head impulse test usually abnormal
Meniere disease Recurrent episodes, last minutes to several hours Spontaneous onset Peripheral characteristics None Episodes may be preceded by ear fullness/pain, accompanied by vertigo, unilateral hearing loss, tinnitus Audiometry shows unilateral low-frequency sensorineural hearing loss
Vestibular migraine Recurrent episodes, last several minutes to hours History of migraine Central or peripheral characteristics may be present Migraine headache and/or other migrainous symptoms either preceding, accompanying, or following vertigo Usually none Between episodes, tests are usually normal
Vertebrobasilar TIA Single or recurrent episodes lasting several minutes to hours Older patient, vascular risk factors, and/or cervical trauma Central characteristics Usually other brainstem symptoms Usually none MRI or MRA may demonstrate vascular lesion
Brainstem infarction Sudden onset, persistent symptoms over days to weeks As above Central characteristics Usually other brainstem symptoms, especially lateral medullary signs Usually none; an exception is anterior inferior cerebellar artery syndrome MRI will demonstrate lesion
Cerebellar infarction or hemorrhage Sudden onset, persistent symptoms over days to weeks Older patient, vascular risk factors, especially hypertension Central characteristics Gait impairment is prominent; headache, limb dysmetria, dysphagia may occur None Urgent MRI, CT will demonstrate lesion
TIA: transient ischemic attack; MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; CT: computed tomography.
* For other diagnoses, refer to UpToDate topics on differential diagnosis of vertigo.
¶ Peripheral characteristics of nystagmus: horizontal or horizontal-torsional; suppresses with visual fixation; does not change direction with gaze. Central characteristics of nystagmus: may be horizontal, torsional, or vertical; does not suppress with visual fixation; may change direction with gaze.
Graphic 81596 Version 13.0