Name a central cause of vertigo that often mimics peripheral vertigo.

• A. Cerebellar stroke or brainstem stroke (e.g., PICA/Wallenberg)
• B. Menière disease
• C. BPPV
• D. Vestibular neuritis

Answer: (A)

A central cause of vertigo that often mimics peripheral vertigo is a stroke affecting the cerebellum or brainstem in the posterior circulation, such as a PICA territory event. This is the best answer because a central lesion can present with vertigo and a spinning sensation just like many peripheral disorders, making initial symptoms look similar. However, central causes carry additional clues on exam and in history. You may see nystagmus that is vertical or direction-changing, poor suppression with fixation, or other neurological findings such as limb ataxia, dysarthria, dysphagia, facial or limb sensory changes, or weakness. These red flags point toward a brainstem or cerebellar problem and demand urgent evaluation to rule out stroke.

In contrast, the other conditions listed are peripheral vestibular disorders. Menière disease features episodic vertigo with fluctuating hearing loss and tinnitus; BPPV presents with brief vertigo triggered by head position and typically has a characteristic fatigable nystagmus and a normal neuro exam between episodes; vestibular neuritis causes acute vertigo lasting days with nausea but without hearing loss and without central neurological signs.