Disease Entities
The vestibular syndromes — from BPPV to posterior-fossa stroke. Diagnostic criteria, exam findings, workup, and management.
Vestibular neuritis
Acute unilateral vestibulopathy producing the prototypical acute vestibular syndrome: severe vertigo, nausea/vomiting, gait imbalance, and spontaneous nystagmus lasting days. The cochlear division is spared (preserved hearing distinguishes it from labyrinthitis).
Benign paroxysmal positional vertigo (BPPV)
Brief episodic vertigo triggered by specific head positions due to free-floating otoconia in a semicircular canal (canalithiasis) or adherent to the cupula (cupulolithiasis). The posterior canal is involved in ~85% of cases.
Ménière's disease
Idiopathic syndrome of recurrent episodic vertigo with fluctuating sensorineural hearing loss, aural fullness, and tinnitus, attributed to endolymphatic hydrops.
Vestibular migraine
The most common cause of recurrent spontaneous vertigo — often misdiagnosed as Ménière's. Bárány/IHS criteria: ≥5 episodes vestibular symptoms (5 min–72 h) + current or past migraine + migraine features during ≥50% of episodes.
Posterior fossa stroke (cerebellar / lateral medullary)
Stroke involving the cerebellum or brainstem can mimic peripheral acute vestibular syndrome but is identified by central exam features. AICA strokes can also produce hearing loss — making this the dangerous mimic of labyrinthitis.
Multiple sclerosis (vertigo manifestations)
MS plaques in the brainstem or cerebellum can produce a wide spectrum of vertigo and oculomotor abnormalities — INO is the classic localizing sign.
Persistent postural-perceptual dizziness (PPPD)
Functional vestibular disorder (Bárány criteria 2017): chronic dizziness/unsteadiness/non-spinning vertigo ≥3 months, present most days, exacerbated by upright posture, motion, and complex visual stimuli.
Superior semicircular canal dehiscence (SSCD)
A bony defect in the roof of the superior (anterior) semicircular canal creates a 'third window' in the labyrinth, allowing sound and pressure to abnormally stimulate the canal and producing vertigo and conductive hyperacusis.