Table 3.

Differentiating features of peripheral and central originated vertigo, nystagmus, ataxia, and headache.

Summary of peripheral vs. central etiology distinguishing features
	Peripheral cause	Central cause
VERTIGO
Onset	Acute or gradual	Acute
Duration	Minutes to hours	Days to weeks
Impact of head movement	Worsens	Variable
Auditory symptoms	Frequent	Often absent
Dix–Hallpike	Positive	Negative
Associated neurological findings	Absent	Often present
NYSTAGMUS
Direction of fast-phase	Unidirectional	Can be alternating
Vertical component	Absent	Can be present
Fatigability	Fatigable in 30–60 s	Not fatigable
Presence of vertigo symptoms	Always present	Can be absent
ATAXIA
Gait ataxia	Present but less severe	Very severe
Truncal ataxia	Uncommon	Common
Cerebellar testing	Normal	Frequently abnormal
Onset	Acute or gradual	Acute
Severity at onset	Less likely to be severe at onset	More likely to be maximal at onset
Headache	Uncommon	Common
Location	Variable	Occipital
Unilateral	Variable	Commonly unilateral
Onset timing	Variable	Typically at time of other symptoms
HINTS
Head impulse test	Abnormal (gaze correction)	Normal
Nystagmus	Fast-phase in one direction	Fast-phase alternating directions
Test of skew	Skew absent	Skew present