Chart — Med-Surg
Vertigo Causes Comparison Chart
Duration does most of the sorting: seconds means BPPV, hours with ear symptoms means Ménière’s, days after a virus means neuritis or labyrinthitis. The chart lines them up — and the red-flag box covers the central causes that mimic all three.
Educational use only. New vertigo with any neurological finding is evaluated as a possible stroke; repositioning maneuvers and medication plans follow provider orders. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
The Peripheral Causes Side by Side
| Feature | BPPV | Ménière’s Disease | Vestibular Neuritis / Labyrinthitis |
|---|---|---|---|
| Mechanism | Displaced otoconia (calcium crystals) tumbling in a semicircular canal | Excess endolymph distending the inner ear (endolymphatic hydrops) | Post-viral inflammation of the vestibular nerve (labyrinthitis: + cochlea) |
| Duration of vertigo | Seconds to a minute per episode | 20 minutes to several hours per attack | Constant for days, improving over weeks |
| Trigger | Head position changes — rolling over, looking up, bending down | Unpredictable attacks; sodium load, caffeine, alcohol, stress implicated | Often follows a viral illness; not positional (though movement worsens it) |
| Hearing involvement | None | Yes — fluctuating sensorineural loss + tinnitus + aural fullness (the triad) | Neuritis: hearing spared. Labyrinthitis: hearing loss/tinnitus present |
| Diagnosis | Dix-Hallpike maneuver reproduces vertigo and nystagmus | Clinical history + audiometry showing fluctuating low-frequency loss | Clinical — constant vertigo, positive head-impulse test, normal neuro exam |
| Treatment | Epley (canalith repositioning) — often curative; home exercises for recurrence | Low-sodium diet (~2 g/day), diuretics, attack meds; intratympanic gentamicin or surgery if refractory | Brief vestibular suppressants, antiemetics, then EARLY mobilization and vestibular rehab |
| Key teaching | Recurrence is common and re-treatable — repeat the maneuver, don't panic | Attack plan (sit/lie immediately), trigger diary, no driving during active periods | Moving (carefully) is the treatment — prolonged suppressants delay recovery |
Central Red Flags — Not on This Chart for a Reason
- ✦Vertigo + diplopia, dysarthria, dysphagia, facial droop, or focal weakness = stroke workup, not meclizine.
- ✦Vertical or direction-changing nystagmus is central; peripheral nystagmus is horizontal/rotary and fatigues.
- ✦Complete inability to stand or sit unsupported — imbalance out of proportion to the spinning — suggests cerebellar cause.
- ✦Sudden severe headache or neck pain with vertigo: think posterior-circulation event.
- ✦Ménière's diet answer = LOW SODIUM; safety during any attack = stop ambulation, dark quiet room, head still.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →