Overview Introduction Vestibular system angular acceleration of the head is detected by the semicircular canals this is secondary to endolymph movement via the ampulla login to view 3 more bullets linear acceleration of the head and head tilt is detected by maculae (which is contained within the utricle and saccule) maculae contain otolith (calcified crystals) login to view 8 more bullets Clinical correlate caloric testing a test that stimulates the vestibulo-ocular reflex via login to view 1 more bullet normal findings login to view 6 more bullets nystagmus describes rhythmic movements of the eye which can result from login to view 1 more bullet vertigo Summary of Peripheral Vs. Central Vertigo Vertigo Type Etiology Differential Symptoms Peripheral vertigo Lesion affecting the vestibular apparatus (in the inner ear) cranial nerve VIII Benign paroxysmal positional vertigo (BPPV) Vestibular neuritis Meniere's disease Acoustic neuroma Aminoglycoside toxicity Semicircular canal dehiscence syndrome Perilymphatic fistula Herpes zoster oticus (Ramsay Hunt syndrome) Intermittent and positional vertigo Can be associated with tinnitus as well as hearing loss postural unsteadiness Nyastagmus is delayed in onset rotatory or horizontal prominent if vertigo is present adaptive Vertigo stops with visual fixation Central vertigo Lesion affecting the brainstem nuclei cerebellum Vestibular migraine Brainstem stroke Multiple sclerosis Ischemic or hemorrhagic damage to the cerebellum Non-positional vertigo May accompany other cranial nerve injuries such as facial droop dysarthria Nystagmus is immediate or delayed in onset rotatory, horizontal, or vertical not adaptive Vertigo does not stop with visual fixation