Characteristics of Peripheral and Central Vertigo

PERIPHERAL VERTIGO

 • Onset: Sudden

 • Intensity: Severe initially, often decreasing over time

 • Duration: Intermittent episodes lasting seconds to less than a minute for BPPV; continuous and lasting hours to days for vestibular neuritis

 • Nystagmus: Usually torsional and upbeat (fast phase beating toward forehead) in classic posterior canal BPPV; horizontal in horizontal canal BPPV; horizontal-torsional in vestibular neuritis/labyrinthitis

 • Head Position: Induces vertigo (BPPV); worsens vertigo (vestibular neuritis)

 • Neuro Findings: None

 • Auditory Findings: May be present, including tinnitus (Méniére's disease) and hearing loss (labyrinthitis)

CENTRAL VERTIGO

 • Onset: Gradual or sudden

 • Intensity: Mild in most but can be severe in stroke and

multiple sclerosis

 • Duration: Usually weeks, months (continuous) but can be seconds or minutes with vascular causes, such as with posterior circulation TIA

 • Nystagmus: Purely vertical, spontaneous and purely torsional, direction-changing on lateral gaze, downbeating (fast phase beats toward nose)

 • Head Position: Usually little change but can worsen with head position change

 • Neuro Findings: Usually present

 • Auditory Findings: Rarely



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