Did your first attack of severe vertigo last hours, with nausea and vomiting? • Vestibular neuritis Are you light-headed when you get up from a bed or chair for a few seconds? • Blood pressure/cardiovascular disease (CVS) Do you pass out completely with your dizziness? • CVS Difference between peripheral and central vertigo Peripheral Central Hallucinations of movement Definite Less definite Onset Usually paroxysmal Seldom paroxysmal Intensity Usually severe Less severe Duration Seconds to hours Weeks to months Induced by head position Frequently Seldom Nystagmus Present Present or absent Nystagmus pattern Uni-directional, increased by Direction changing, no loss of fixation change with fixation, other forms of nystagmus Autonomous nervous system Definite Less definite or absent symptoms Tinnitus Frequently present Seldom present Hearing loss Frequently present Seldom present Disturbance of Absent More frequently present consciousness Other neurological signs Usually absent Frequently present Differential diagnosis of vertigo Peripheral Central Common Common Phobic postural vertigo • Vestibular neuritis Vestibular migraine • • Meniere’s disease Pathological forms of nystagmus, e.g. • • Bilateral vestibulopathy Down-beat nystagmus • • Vestibular schwannoma/acoustic Up-beat nystagmus • • neuroma Gaze nystagmus • Rare Rare semi-circular canal dehiscence positioning vertigo (SSCD) Dizziness syndromes of unclear • Vestibular paroxysmia (vascular loop aetiology/familial • compression) Episodic ataxia type II • Perilymph fistula Arnold-Chiari malformation • • Labyrinthitis Psychogenic dizziness • • Auto-immune inner-ear diseases • Other problems (physiological/ CNS disease (causes) pathological stimulation) Multiple sclerosis • disease Vascular disease • Caloric stimulation Tumours • • Water exposure Epilepsy • •
• Did your first attack of severe vertigo last hours, with nausea and vomiting? Vestibular neuritis • Are you light-headed when you get up from a bed or chair for a few seconds? Blood pressure/cardiovascular disease (CVS) • Do you pass out completely with your dizziness? CVS Difference between peripheral and central vertigo Peripheral Central Hallucinations of movement Definite Less definite Onset Usually paroxysmal Seldom paroxysmal Intensity Usually severe Less severe Duration Seconds to hours Weeks to months Induced by head position Frequently Seldom Nystagmus Present Present or absent Nystagmus pattern Uni-directional, increased by loss of fixation Direction changing, no change with fixation, other forms of nystagmus Autonomous nervous system symptoms Definite Less definite or absent Tinnitus Frequently present Seldom present Hearing loss Frequently present Seldom present Disturbance of consciousness Absent More frequently present Other neurological signs Usually absent Frequently present Differential diagnosis of vertigo Peripheral Central Common • Vestibular neuritis • Meniere’s disease • Bilateral vestibulopathy • Vestibular schwannoma/acoustic neuroma Common • Phobic postural vertigo • Vestibular migraine • Pathological forms of nystagmus, e.g. • Down-beat nystagmus • Up-beat nystagmus • Gaze nystagmus Rare semi-circular canal dehiscence (SSCD) • Vestibular paroxysmia (vascular loop compression) • Perilymph fistula • Labyrinthitis • Auto-immune inner-ear diseases Rare positioning vertigo • Dizziness syndromes of unclear aetiology/familial • Episodic ataxia type II • Arnold-Chiari malformation • Psychogenic dizziness Other problems (physiological/ pathological stimulation) disease • Caloric stimulation • Water exposure CNS disease (causes) • Multiple sclerosis • Vascular disease • Tumours • Epilepsy
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