What is the differential diagnosis for dizziness?

Peripheral vertigo

• Benign paroxysmal positional vertigo
• Labyrinthitis
• Vestibular neuronitis
• Meniere’s disease
• Cholesteatoma
• Ototoxic drugs

Central vertigo

• CNS disease (multiple sclerosis)
• Cerebrovascular disorders (cerebellar stroke or hemorrhage, vertebrobasilar insufficiency*, normal pressure hydrocephalus)
• Tumors (acoustic neuroma)
• Infection (meningitis, syphilis, cerebellar abscess)
• Trauma (cerebellar contusion)
• Toxic exposure (alcohol, hypnotics, drugs)

Non-vertiginous dizziness

• Syncope or presyncope
• Cardiac arrhythmias, aortic stenosis
• Vasovagal
• Orthostatic hypotension
• Visual impairment
• Metabolic disease (diabetes, hypoglycemia, hypothyroidism)

Vertigo caused by a peripheral lesion will not last longer than a few weeks due to compensation. They are also more likely to produce intermittent attacks of imbalance, severe nausea and vomiting, unidirectional nystagmus, and auditory symptoms (but should not be associated with other neurological symptoms). Central lesions do not compensate, thus vertigo will not pass. It will also produce severe imbalance, variable nausea and vomiting, bidirectional nystagmus, and neurological symptoms (rarely auditory symptoms).

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This post was written by Omar Rifai