Central Vertigo Diagnosis and Management

Clinical Characteristics of Central Vertigo

The American Academy of Otolaryngology-Head and Neck Surgery suggests that nystagmus of changing direction without changes in head position is indicative of central vertigo 1
Nystagmus downward in the Dix-Hallpike maneuver, especially without a torsional component, is a sign of central vertigo 1
Nystagmus of changing direction, such as to the right with gaze to the right and to the left with gaze to the left, is a characteristic of central vertigo 1
Basal nystagmus that manifests without provocative maneuvers is a sign of central vertigo 1
Lack of response to canalith repositioning maneuvers or vestibular rehabilitation is suggestive of central vertigo 1

The American Academy of Otolaryngology-Head and Neck Surgery reports that vestibular migraine has a prevalence of 3.2% and may represent up to 14% of vertigo cases 1
Stroke or transient ischemic attack of the brainstem and cerebellum can cause central vertigo 1

The American Academy of Otolaryngology-Head and Neck Surgery recommends evaluating if vertigo is provoked by positional changes relative to gravity or is spontaneous 2
Evaluation of gait and balance is crucial in the diagnosis of central vertigo 1
The American College of Radiology suggests that brain MRI with and without contrast, especially to evaluate the posterior fossa, is a useful diagnostic tool 3

The American Academy of Otolaryngology-Head and Neck Surgery recommends that treatment should be directed at the underlying cause of central vertigo 1
In cases of stroke, urgent neurological management is required 1
For vestibular migraine, prophylactic treatment for migraine should be considered 1

Approximately 3% of patients with failed treatment for benign paroxysmal positional vertigo (BPPV) may have an underlying central nervous system disorder 2
Patients with symptoms consistent with BPPV who do not show improvement after repositioning maneuvers, especially after 2-3 attempts, should be evaluated for central pathology 5
A study of 240 cerebellar strokes found that 10% presented similarly to a peripheral vestibular process 1