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There are certain signs and symptoms that are typically associated with vertigo regardless of the underlying cause. These include: sensation of rotational spinning; nystagmus (abnormal rhythmic eye movement); dizziness; and nausea/vomiting.

The intensity and duration of any of these symptoms may be related to the underlying medical condition with which the vertigo is associated (e.g., vertigo attack of Meniere's disease may last up to a few hours). There are some variations, though, that are more likely to be associated with either peripheral or central vertigo.

Peripheral Vertigo

Vestibular Neuritis

The predominant signs and symptoms of vestibular neuritis include:

• Acute onset of severe, prolonged, rotatory vertigo
• Nystagmus
• Postural imbalance
• Nausea
• Symptoms may last for 1-6 weeks

Perilymphatic Fistula

Signs and symptoms of perilymphatic fistula include:

• Episodic vertigo
• Sensorineural hearing loss
• Vestibular (balance) dysfunction
• Symptoms may be exacerbated by pressure (e.g., sneezing, lifting) or certain head movements
• Symptoms may appear either separately or in combination and usually resolve after 2-3 weeks

Meniere's Disease

Signs and symptoms of Meniere's disease may include:

• Rotation vertigo
• Nausea/vomiting
• Tinnitus (ringing in the ears)
• Fluctuating, low-tone sensorineural hearing loss
• Pressure or fullness in the affected ear
• Spontaneous nystagmus
• Duration of attacks is at least 1 hour
• Dizziness and unsteadiness may remain for a few days after the attack

Benign Paroxysmal Positional Vertigo

Many people experience their first attack of benign paroxysmal positional vertigo when waking up in the morning and are quite frightened by the intensity of the symptoms. The actual vertigo is usually of short duration (less than a minute) but the intensity of the sensation is so strong that the patient often reports experiencing a much longer attack. Often people can identify the exact movement that causes their vertigo and they tend to avoid making these movements in order to avoid the onset of symptoms.

The onset of symptoms in an acute attack of vertigo may develop in the following sequence:

• Initially the individual may experience vague dizziness accompanied by spontaneous nystagmus with eyes beating towards the affected side. Nausea and/or vomiting may develop at this point.

• The individual then may experience a sudden loss of function with the onset of intense vertigo with continued nystagmus. Nausea and vomiting often intensify at this point. All of the symptoms are present in every position of the head. There is also a feeling of unsteadiness and gait deviation towards the affected side if the individual is standing.

• After a short duration, the individual may experience a sudden decrease of symptoms while lying still. Sudden movements of the head can cause the symptoms to reappear.

• Full recovery usually follows though there may be a lingering nystagmus or sensation of vertigo.

• Nystagmus is paroxysmal (sudden) and beats towards the affected ear. It is usually a clockwise nystagmus which may then switch to beating in a counterclockwise direction. Characteristics of the nystagmus associated with benign paroxysmal positional vertigo include:

  • short latency - the eyes begin beating soon after the commencement of the vertigo attack