Diagnostic Algorithm for Dizziness and Vertigo

Peripheral Vertigo:

 • Attacks: Sudden, severe, can last anywhere from seconds to minutes to days

 • Nystagmus: Varies

 • No neurologic findings

 • Auditory findings may be present

Central Vertigo:

 • Attacks: Gradual, mild, usually continuous for weeks or months but can be sudden, severe and seconds or minutes with vascular causes

 • Nystagmus: Varies 

 • Can worsen with head position change

 • Neurologic findings usually present

 • No auditory findings

BPPV

 • Short-lived, positional episodes caused by stray otoliths in semicircular canal. Positive Hallpike test (posterior canal) or supine roll test (horizontal canal)

Vestibular neuritis/labyrinthitis

 • Severe vertigo for days. Mild persistent vertigo up to weeks and months. No auditory symptoms (vestibular neuritis); positive hearing loss (labyrinthitis). Positive head impulse test

Méniére's disease

 • Tinnitus. Hearing loss. Attacks in clusters. Long symptom-free intervals



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