Version October 2024
| 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 |
CT: computed tomography; MRA: magnetic resonance angiography; MRI: magnetic resonance imaging; TIA: transient ischemic attack.
* 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.Do you want to add Medilib to your home screen?
