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Table 51-1

Features of Peripheral and Central Vertigo

  • Nystagmus from an acute peripheral lesion is unidirectional, with fast phases beating away from the ear with the lesion. Nystagmus that changes direction with gaze is due to a central lesion.
  • Transient mixed vertical-torsional nystagmus occurs in BPPV, but pure vertical or pure torsional nystagmus is a central sign.
  • Nystagmus from a peripheral lesion may be inhibited by visual fixation, whereas central nystagmus is not suppressed.
  • Absence of a head impulse sign in a pt with acute prolonged vertigo should suggest a central cause.
  • Unilateral hearing loss suggests peripheral vertigo. Findings such as diplopia, dysarthria, and limb ataxia suggest a central disorder.

Abbreviation: BPPV, benign paroxysmal positional vertigo.