Overview Introduction Vestibular system login to view 15 more bullets Clinical correlate login to view 14 more bullets 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