- Benign paroxysmal positional vertigo - Hallpike’s test diagnostic
- Meniere's disease
- labyrinthitis: ± URTI prodrome
- posterior stroke: other focal neurology e.g. Acute ataxia
- Otitis media
- acoustic neuroma: slow onset deafness (rarely causes vertigo)
- trauma, foreign body
- vestibular neuronitis: post-infectious, hearing is normal
- migraine
- drug-induced: gentamicin, co-trimoxazole, diuretics, metronidazole
red flags for central cause
- new onset headache, Head injury
- other focal neurology - cranial nerve palsy, etc.
- ataxia
more likely to be peripheral if:
- hearing loss (although stroke can cause hearing loss also)
- N+V
| Part |
Posterior stroke will give... |
| Head impulse |
Normal/negative head impulse test |
| Nystagmus |
Rotatory/vertical nystagmus; direction-changing horizontal nystagmus |
| Test of skew |
Skew deviation/positive vertical skew test |
- Betahistine - H1 receptor agonist, H3 antagonist → ↑ cochlear blood flow ...? inhibition spike generation of neurons in vestibular nuclei