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Other more serious central causes include tumors, particularly those arising from the cerebellopontine angle. Ischemic or hemorrhagic strokes, particularly involving the cerebellum or vertebrobasilar system, are life-threatening and must be ruled out by history, physical and other diagnostic tests if warranted. Ĭentral etiologies of vertigo should always be considered in the differential. A perilymphatic fistula is another less common cause of peripheral vertigo and results from trauma. Otosclerosis is characterized by abnormal growth of bone in the middle ear, which leads to conductive hearing loss and may affect the cochlea, also causing tinnitus and vertigo. Cholesteatomas most often involve the middle ear and mastoid. Cholesteatomas are cyst-like lesions filled with keratin debris. Less common peripheral causes include cholesteatoma, otosclerosis, and a perilymphatic fistula.

The facial nerve is often involved as well, resulting in facial paralysis. In Ramsay Hunt syndrome, vertigo results from reactivation of latent Varicella-zoster virus (VZV) in the geniculate ganglion leading to inflammation of the vestibulocochlear nerve. Another viral-induced cause of vertigo includes Herpes zoster oticus, also known as Ramsay Hunt syndrome. Both arise from inflammation, often caused by a viral infection. Two additional distinct causes of peripheral vertigo include acute labyrinthitis and vestibular neuritis. Symptoms of Ménière disease result from an increased volume of endolymph in the semicircular canals. Unlike BPPV, the patients with Ménière disease often experience tinnitus, hearing loss, and aural fullness in addition to vertigo. Endolymphatic hydrops is a distinct pathologic feature of Ménière disease. BPPV results from calcium deposits or debris in the posterior semicircular canal and causes frequent transient episodes of vertigo lasting a few minutes or less. Peripheral etiologies include the more common causes of vertigo, such as benign paroxysmal positional vertigo (BPPV) and Ménière disease. Vertigo is most often caused by a dysfunction in the vestibular system from a peripheral or central lesion.