Module 8
How the anatomy maps onto disease — the localisation logic of vestibular medicine: peripheral versus central vertigo, the acute vestibular syndrome, BPPV, Ménière's, and the central disorders.
Vertigo can arise anywhere along the vestibular pathway — the inner ear, the nerve, the brainstem, or the cerebellum. The first and most important clinical task is to decide whether the cause is peripheral or central, because the urgency and the treatment differ completely.62
The acute vestibular syndrome is sudden, severe, continuous vertigo with nausea, unsteady gait, and nystagmus, lasting days. Most cases are vestibular neuritis — but a minority are a brainstem or cerebellar stroke, and the two can look alike.38
BPPV is the commonest cause of vertigo. It produces brief spinning — seconds to a minute — triggered by a change in head position, such as rolling over in bed or looking up.17
Ménière's disease causes recurrent attacks of vertigo lasting minutes to hours, together with fluctuating hearing loss, tinnitus, and a sense of fullness in the affected ear.33
Not all recurrent vertigo comes from the inner ear. Disorders of the central vestibular pathways produce their own characteristic patterns.62