. Author manuscript; available in PMC: 2010 Feb 1.

Published in final edited form as: Emerg Med Clin North Am. 2009 Feb;27(1):39–viii. doi: 10.1016/j.emc.2008.09.002

Table.

Summary of the features of the most common categories of dizziness presentations.

Dizziness Presentation Category	Main symptoms	Peripheral vestibular signs	Central nervous system signs^**	Potential causes
Acute Severe Dizziness	Sudden onset, severe & constant dizziness, nausea and vomiting, and imbalance	Unidirectional Spontaneous nystagmus, positive head thrust test	Down-beat or bidirectional gaze-evoked nystagmus, severe imbalance	PV: Vestibular neuritis CNS: Stroke
Recurrent Positional Dizziness	Dizziness attacks triggered by head movements	-Attacks last less than 1 minute. Normal in-between attacks. -Dix-Hallpike test: Burst of upbeat torsional nystagmus. -Epley maneuver: Resolution of signs & symptoms.^*	-Attacks can be of short or long duration. Less severe dizziness symptoms may persist between attacks. -Dix-Hallpike test: Persistent down-beating nystagmus or pure torsional nystagmus. -Epley maneuver: No effect.	PV: BPPV CNS: Chiari malformation, cerebellar tumor, degenerative ataxia.
Recurrent Attacks of Dizziness	Spontaneous attacks of dizziness	Duration: >20 minutes to hours. Associated unilateral hearing loss, roaring tinnitus, or ear fullness	Duration: Minutes. New onset and crescendo pattern.	PV: Meniere’s disease CNS: TIA

See text for details regarding less common types of BPPV

^**

Any other CNS symptom as well (speech alteration, focal weakness, focal sensory features).

PV = peripheral vestibular; CNS = central nervous system; TIA = transient ischemic attack