Vestibulum — Vertigo Teaching Atlas

A note on use: this is a teaching aid, not a diagnostic engine. The ranking is based on feature-by-feature weights, not Bayesian probability. Use it to think about which findings drive your differential, then verify against the full clinical picture, Bárány criteria, and imaging where indicated.

Timing & duration

Acute, continuous vertigo (lasting days)Recurrent spontaneous episodes (minutes–hours)Brief episodes triggered by head position (seconds)Chronic dizziness ≥3 monthsFirst-ever episode (no prior history)

Auditory symptoms

Triggers

Nystagmus pattern

Direction-fixed horizontal (± torsional)Direction-changing on gazeVertical (up- or downbeat)Positional only, with latency & fatiguePositional, persistent, no latency / no fatiguePendular or dissociatedSuppressed by visual fixation

Central / brainstem signs

Skew deviation on cover testHead impulse test NORMAL (in AVS)Truncal ataxia (cannot sit/stand)Limb dysmetria / dysdiadochokinesiaINO (impaired adduction)Other cranial nerve / sensorimotor deficit

Background

Vascular risk factors (HTN, DM, smoker, AFib)Recent prior vestibular eventPersonal/family migraine historyPrior optic neuritis or other demyelinating eventYoung adult, female

Tick at least one finding to see the differential.

Differential Diagnosis Tool

Selected findings