Vertigo

CLINICAL DIAGNOSTIC MANUAL

Vertigo is an illusionary sensation of movement, often described as if the surroundings are spinning around the person or vice versa. This symptom is a common reason for medical consultation, especially in emergency medicine and neurology. It differs from simple dizziness in that it involves a clear sensation of rotational movement. Vertigo may be accompanied by nausea, vomiting, and balance disturbances, reflecting dysfunction in the vestibular system either at the central level (brain) or peripheral level (inner ear).

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Vestibular Neuritis	Severe vertigo, instability, nystagmus, absence of auditory symptoms.	Clinical history and characteristic symptoms.	Vestibular tests showing unilateral vestibular nerve dysfunction.
Labyrinthitis	Vertigo, hearing loss, nystagmus, possibly tinnitus.	Vertigo symptoms combined with hearing loss.	Audiometry and vestibular tests; MRI in doubtful cases to exclude others.
Ménière’s Disease	Recurrent episodes of vertigo, fluctuating hearing loss, tinnitus, feeling of fullness in the ear.	Recurrent vertigo episodes with documented hearing loss.	Audiometry showing fluctuating sensorineural hearing loss.
Benign Paroxysmal Positional Vertigo (BPPV)	Brief but intense vertigo triggered by head position changes, observable nystagmus during the episode.	Clinical history with typical episodes triggered by position changes.	Repositioning manoeuvres that resolve symptoms.
Cerebellopontine Angle Tumour	Vertigo, unilateral hearing loss, possibly tinnitus or facial weakness.	Presence of unilateral auditory and vestibular symptoms.	MRI showing tumour in the cerebellopontine angle.
Stroke	Vertigo, possibly accompanied by other neurological signs such as weakness, speech difficulty, visual disturbances.	Vertigo symptoms combined with other focal neurological deficits.	Brain MRI or CT imaging.
Multiple Sclerosis	Vertigo, nystagmus, other neurological symptoms such as double vision or numbness.	Vertigo along with other neurological symptoms and evidence of demyelinating lesions.	MRI showing multiple demyelinating lesions.
Vestibular Migraine	Vertigo, sensitivity to light or sound, often accompanied by headache.	History of migraine with or without aura, with vertigo as a prominent component.	Clinical diagnosis based on history and exclusion of other causes.