09/09/2026
CENTRAL vs. PERIPHERAL VESTIBULAR DISORDERS 🧠👂
Dizziness and vertigo can look very similar—but the underlying cause can be very different.
A few clinical clues can help you determine whether you’re seeing more of a peripheral vestibular pattern or a central vestibular pattern.
🔹 Peripheral clues:
• Usually unidirectional nystagmus
• Abnormal HIT with acute unilateral loss
• Positional or movement-provoked symptoms
• Hearing symptoms may be present
🔹 Central clues:
• Direction-changing, vertical, or atypical nystagmus
• Normal HIT despite significant acute vertigo
• Disproportionate gait or truncal ataxia
• Oculomotor or other neurologic findings
⚠️ Remember: These are clinical clues—not standalone diagnostic rules. Patients can have both central AND peripheral vestibular dysfunction, and the entire clinical picture matters.
For vestibular clinicians: Which finding makes you most suspicious of a central cause?
📌 Save this chart for your next vestibular evaluation.
📲 Share it with a PT, OT, SLP, or student who is learning vestibular rehab.
Dizziness Vertigo VestibularDisorders VestibularAssessment CentralVestibular PeripheralVestibular PhysicalTherapist VIZSTIM RewireRebalanceRecover