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 #Dizziness #Vertigo #Algorithm #differential #diagnosis #neurology
