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 #Peripheral #Central #Vertigo #diagnosis #findings #signs #symptoms #comparison #neurology
