Vertigo Causes and Diagnosis

Primary Peripheral Causes

The American Academy of Otolaryngology-Head and Neck Surgery states that benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in adults, accounting for approximately 42% of cases in primary care settings, with brief episodes of vertigo lasting seconds to less than one minute, triggered by specific head position changes 1, 2, 3, 4
Vestibular neuritis is characterized by acute prolonged vertigo lasting 12-36 hours with severe nausea and vomiting, and no associated hearing loss, tinnitus, or aural fullness, with a viral infection of the vestibular system and decreasing disequilibrium over 4-5 days 3, 4
Ménière's disease is associated with episodic vertigo attacks lasting 20 minutes to 12 hours, fluctuating low-to-mid frequency hearing loss, tinnitus, and aural fullness in the affected ear, and may present with vague dizziness rather than frank vertigo in elderly patients 3, 5, 6

Posterior circulation stroke/ischemia can cause vertigo lasting minutes with nausea, vomiting, and severe imbalance, and may include visual blurring, drop attacks, dysphagia, dysphonia, or other neurologic symptoms, with a prevalence of up to 25% in patients presenting with acute vestibular syndrome, and up to 75% in high vascular risk cohorts 3, 4, 6, 9
The American College of Radiology notes that 75-80% of patients with stroke-related acute vestibular syndrome have no focal neurologic deficits, highlighting the importance of careful evaluation 9

In adults aged >65 years, one in three falls annually, with dizziness/vertigo deemed the primary etiology in 13% of falls, creating significant morbidity risk, with fall-related costs exceeding $20 billion annually in the United States 7, 8
Undiagnosed BPPV is common in elderly patients, with 9% of patients referred to a geriatric clinic having undiagnosed BPPV, and three-fourths of those with BPPV having fallen within the preceding 3 months 7

The American Academy of Otolaryngology-Head and Neck Surgery advises against dismissing isolated vertigo without focal neurologic findings as benign, as 11% of such patients presenting with acute persistent vertigo have acute infarct on imaging 9
Elderly patients may describe "vague dizziness" rather than true spinning vertigo, even with significant inner ear pathology, highlighting the importance of careful evaluation 3, 6