Vertigo due to peripheral lesions

• in peripheral vertigo (1)
  • hearing loss and tinnitus are commoner than in central vertigo
  • generally has a more sudden onset (exception-acute cerebrovascular events)
  • is highly associated with rotatory illusions (esp. nausea and vomiting)
  • nystagmus is combined horizontal and rotational, and lessens when the gaze is focussed
  • there is mild to moderate imbalance
  • nonauditory neurologic symptoms are rare
  • latency following provocative diagnostic maneuver is longer (up to 20 seconds)
• the duration of vertiginous episodes and the presence or absence of auditory symptoms narrows the differential diagnosis (2)
  • causes of vertigo in which there are accompanying auditory symptoms:
    • Meniere's disease:
      • vertigo lasts for minutes or hours
      • episodic, associated with tinnitus and deafness
    • acute labyrinthitis - vertigo lasts for days
    • perilymphatic fistula - vertigo lasts for months/years
    • ototoxic drugs e.g. aminoglycosides
    • cholesteatoma
    • Ramsay-Hunt syndrome
  • causes of vertigo in which there is no hearing loss / tinnitus:
    • benign positional vertigo:
      • vertigo lasts for seconds
      • episodic, correlated with head position
    • vestibular neuronitis - vertigo lasts for days
    • cervical spondylosis and whiplash injury may cause vertigo by interfering with proprioception and movement of the neck

Reference:

• (1) Ronald H. Labuguen. Initial Evaluation of Vertigo. Am Fam Physician 2006;73:244-51, 254
• (2) Randy Swartz. Treatment of vertigo. Am Fam Physician 2005;71:1115-22, 1129-30