Clinical features of peripheral versus central vertigo

	Peripheral	Central
Nystagmus
Features (direction and type)	Unidirectional, fast component toward the normal ear; never reverses direction Horizontal with a torsional component; never purely torsional or vertical	Sometimes reverses direction when patient looks in the direction of slow component Can be any direction; note that purely vertical or purely torsional nystagmus is a central sign
Effect of visual fixation	Suppressed	Not suppressed
Postural instability	Unidirectional instability, walking preserved	Severe instability, patient often falls when walking
Deafness or tinnitus	May be present	Usually absent
Other neurologic signs and symptoms	Absent	Often present (eg, diplopia, ataxia, dysarthria, dysphagia, focal or lateralized weakness)

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