Features of Peripheral and Central Vertigo

Sign or Symptom	Peripheral (Labyrinth or Vestibular Nerve)	Central (Brainstem or Cerebellum)
Direction of associated nystagmus	Unidirectional; fast phase opposite lesiona	Bidirectional (direction-changing) or unidirectional
Purely horizontal nystagmus without torsional component	Uncommon	May be present
Purely vertical or purely torsional nystagmus	Never presentb	May be present
Visual fixation	Inhibits nystagmus	No inhibition
Tinnitus and/or deafness	Often present	Usually absent
Associated central nervous system abnormalities	None	Extremely common (e.g., diplopia, hiccups, cranial neuropathies, dysarthria)
Common causes	Benign paroxysmal positional vertigo, infection (labyrinthitis), vestibular neuritis, Ménière's disease, labyrinthine ischemia, trauma, toxin	Vascular, demyelinating, neoplasm

^a In Ménière's disease, the direction of the fast phase is variable.

^b Combined vertical-torsional nystagmus suggests BPPV.