Vertigo when patient is still | No | Yes | Yes |
Patient is able to stand unaided | Yes | Yes | May not be able to |
Spontaneous and/or gaze-evoked nystagmus | No | Yes | Yes |
Typical spontaneous or gaze-evoked nystagmus observed | Not present | Undirectional horizontal/rotatory Not purely vertical | Various, including bidirectional horizonal/rotatory; sometimes vertical |
Worse when patient moves their head | Yes | Yes | Yes |
Other neurologic symptoms or findings | No | No | Often but not always present |
New hearing loss | No | No | Can occur |
Appropriate to perform Dix–Hallpike test | Yes | No | No |
Nystagmus produced during Dix–Hallpike test | Vertical upward and rotatory | Do not perform Dix–Hallpike test | Do not perform Dix–Hallpike test |
Appropriate to perform HINTS plus examination | No | Yes | Yes |
Results from HINTS plus examination | Do not perform HINTS plus testing | All 4 findings: Undirectional nystagmus No vertical skew Abnormal HIT No hearing loss HINTS plus = peripheral | Any of: Bidirectional nystagmus Vertical skew present Normal HIT New hearing loss HINTS plus = central |
Imaging indicated | No | No | Yes |
Primary treatment | Epley maneuver | Supportive treatment | Treatment for stroke |