Which bedside findings suggest central vertigo rather than peripheral vertigo?

Which bedside findings suggest central vertigo rather than peripheral vertigo?

• A. Vertical nystagmus with skew deviation and brainstem signs
• B. Fatigable spinning with horizontal-torsional nystagmus
• C. Positive head impulse test
• D. Hearing loss and tinnitus

Answer: (A)

At the bedside, central vertigo is suggested by eye movement patterns that point to brainstem or cerebellar involvement. Vertical nystagmus, especially when it occurs with a skew deviation (a vertical misalignment of the eyes), along with other brainstem signs, indicates a lesion higher up in the neural pathways controlling eye movements. This contrasts with peripheral vertigo, where the nystagmus is typically horizontal-torsional and tends to fatigue, with a head impulse test that is abnormal on the affected side. Peripheral causes may also present with hearing changes like loss or tinnitus, which point to inner ear pathology rather than central processes. So the finding of vertical nystagmus with skew deviation and brainstem signs best signals central vertigo.

At the bedside, central vertigo is suggested by eye movement patterns that point to brainstem or cerebellar involvement. Vertical nystagmus, especially when it occurs with a skew deviation (a vertical misalignment of the eyes), along with other brainstem signs, indicates a lesion higher up in the neural pathways controlling eye movements. This contrasts with peripheral vertigo, where the nystagmus is typically horizontal-torsional and tends to fatigue, with a head impulse test that is abnormal on the affected side. Peripheral causes may also present with hearing changes like loss or tinnitus, which point to inner ear pathology rather than central processes. So the finding of vertical nystagmus with skew deviation and brainstem signs best signals central vertigo.