Distinguishing and treating causes of central vertigo

Because the membranous labyrinth and the central nervous system contents of the posterior fossa are nourished by the vertebrobasilar circulation, localization of a lesion as central or peripheral in a vasculopathic patient may have little consequence in terms of his or her future risk for stroke. Distinguishing a gaze evoked direction changing nystagmus from a unidirectional spontaneous nystagmus accentuated with gaze in the quick phase direction may be the only key to properly diagnosing a cerebellar infarction presenting as an acute labyrinthine condition. Progression of cerebellar ataxia over weeks should prompt an aggressive evaluation for neoplastic disease, especially in women.