Illusion of movement from vestibular dysfunction; distinguishing peripheral from central causes drives management.
Examination
- • Dix–Hallpike for BPPV
- • HINTS exam in acute vestibular syndrome
- • Nystagmus characteristics, gait, cerebellar signs
- • Otoscopy and hearing assessment
Differential diagnosis
- • BPPV (seconds, positional)
- • Vestibular neuritis (days, no hearing loss)
- • Ménière's (minutes-hours with hearing loss and tinnitus)
- • Posterior circulation stroke
- • Vestibular migraine
Management
- • BPPV: Epley manoeuvre
- • Vestibular neuritis: short prochlorperazine then vestibular rehabilitation
- • Ménière's: salt restriction, betahistine
- • Suspected central cause: urgent MRI and stroke pathway
Clinical pearls
- • Normal head impulse test with direction-changing nystagmus means central until proven otherwise
- • Avoid prolonged vestibular sedatives — they delay compensation
Related in WardRound
Educational — verify locally.
