Differential diagnosis

• the following conditions may be associated with recurrent vertigo (1)
  • Benign paroxysmal positional vertigo - vertigo is provoked by a change in position and lasts for seconds
  • Meniere's disease - vertigo occurs spontaneously, lasts for minutes to hours, and is accompanied by unilateral hearing loss and tinnitus
  • migraine - vertigo is highly variable in duration and usually precedes or is accompanied by headache
  • vertebrobasilar insufficiency - is associated with brain-stem symptoms such as diplopia, dysarthria, and facial numbness.
  • panic disorder
    
    
• positional vertigo and nystagmus may be caused by:
  • cerebellar disease
  • brain stem disease
    
    
• in central causes of positional vertigo and nystagmus several features are different:
  • the nystagmus continues indefinitely as long as the provoking position is maintained
  • the direction of the nystagmus may not be towards the lower ear

Reference:

• (1) Furman JM, Cass SP. Benign paroxysmal positional vertigo. N Engl J Med 1999;341:1590