What symptoms distinguish central from peripheral vertigo

What symptoms distinguish central from peripheral vertigo

What signs and symptoms help distinguish central from peripheral vertigo

Central versus Peripheral Vertigo

Signs and SymptomsCentral VertigoPeripheral Vertigo
NystagmusOften vertical or rotatory, may change with direction of gaze, increase with looking toward side of lesionMostly horizontal or sometimes rotatory; unidirectional and conjugate; increases with looking away from side of lesion
Latency of onset and duration of nystagmusNo latency after head motion; persistent and lasts >60 secondsLatency after head motion; fatigable and lasts <60 seconds
Caloric testMay be normalAbnormal on side of lesion
Brain stem or cranial nerve signsOften presentAbsent
Hearing loss, tinnitusAbsentOften present
Nausea and vomitingUsually absentUsually present
VertigoUsually mildSevere, often rotational
FallingOften falls toward side of lesionOften falls to side opposite nystagmus
Visual fixation or eye closingNo change or increase of symptomsInhibits nystagmus and vertigo
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