Which feature favors central vertigo over peripheral vertigo?

• A. Latent onset and fatigability of nystagmus
• B. Hearing loss accompanying vertigo
• C. Direction-changing nystagmus, vertical nystagmus, and neurological signs
• D. Spinning sensation relieved by rest

Answer: (C)

The key idea is that central vertigo often comes with eye movements and other brain-related signs that peripheral vertigo does not. When nystagmus can change direction with gaze, is vertical, and occurs alongside neurological findings (like ataxia or limb signs), it points to a lesion in the brainstem or cerebellum where eye-movement control sits. Peripheral vertigo, by contrast, usually produces a single-direction nystagmus (horizontal or rotary) that fatigues with repetition and is not accompanied by neurologic deficits. Hearing loss with vertigo also suggests a peripheral problem, while a spinning sensation that simply eases with rest is not specific to central involvement. So, the combination of direction-changing nystagmus, vertical nystagmus, and neurological signs best favors central vertigo.