Central vertigo is a type of dizziness originating from the central nervous system, such as the brainstem or cerebellum. Neurological conditions such as stroke, tumors, and multiple sclerosis are among the most common causes. Imbalance, double vision, and speech disorders may accompany it.

Neurological examination, brain imaging, and vestibular tests are used in diagnosis. Distinguishing central vertigo from peripheral vertigo is of great importance in determining the treatment approach.

Treatment is planned according to the underlying cause. While stroke-related cases require emergency intervention, specific treatment protocols are applied for tumors or multiple sclerosis.

Rehabilitation, balance training, and neurological follow-up are part of the process in central vertigo. Regular physician follow-up and an individualized treatment plan are required for long-term control.

Definition	A type of dizziness that develops due to a problem in the brainstem, cerebellum, brain, or any part of the central nervous system.
Causes	– Stroke (cerebral vascular blockage or bleeding) – Brain tumors – Multiple sclerosis (MS) – Traumatic brain injury – Migraine-associated vertigo.
Symptoms	– Severe and persistent dizziness – Double vision, blurred vision – Speech disorder – Weakness in the arms or legs – Loss of coordination – Balance problems.
Diagnostic Methods	– Neurological examination – Imaging (MRI, CT) – Audiometric and vestibular tests – Blood tests.
Treatment Methods	– Treatment of the Underlying Cause: – Stroke: Thrombolytic treatment or surgery – Tumor: Surgical intervention or radiotherapy – MS: Treatments that suppress the immune system. – Rehabilitation: Vestibular rehabilitation treatment and neurological rehabilitation.
Risk Factors	High blood pressure, diabetes, heart disease, migraine, and a family history of central nervous system disease.
Complications	Permanent loss of balance, vision problems, and severe limitations in daily activities.
Follow-up and Recommendations	Regular neurological follow-up, a balanced diet, and gradually increasing physical activity.

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How Does Central Vertigo Occur? What Are Its Symptoms?

In peripheral vertigo (for example, BPPV, Ménière’s disease, etc.), the individual feels that the surroundings are spinning when the eyes are open and that they themselves are spinning when the eyes are closed. In central vertigo, however, the individual feels that they themselves are spinning even while motionless and with the eyes open. This condition results from dysfunction of the vestibular structures of the central nervous system.

Patients with central vertigo generally consult a physician because of dizziness and hallucinations of movement. Vomiting and nausea are not prominent. Secondary symptoms such as gait and balance disorders, speech disorders, and double vision may also accompany it. The patient frequently has difficulty finding direction and maintaining balance while walking. In addition, patients may sometimes experience additional symptoms such as headache or hearing loss. These symptoms may occur while moving or remaining still. These findings indicate that central vertigo may originate from a problem in the brainstem or cerebellum. Therefore, when these symptoms occur, rapid and careful evaluation is important.

Dizziness and balance problems are among the symptoms most frequently reported by patients.
Abnormalities in eye movements, particularly the characteristics of nystagmus, are among the distinguishing features of central vertigo.
It makes it difficult for patients to continue their daily activities.

Neurological tests are extremely important during the physical examination. Specialized examination techniques such as the HINTS test may be used. This test can be performed even in emergency settings and interpreted with the naked eye. The HINTS examination has high accuracy and specificity in distinguishing peripheral vertigo from central vertigo. Nystagmus (involuntary eye movements) is frequently observed during the examination. The patterns of this nystagmus can be analyzed easily and rapidly by clinicians to reach a differential diagnosis. If central vertigo is suspected, immediate steps should be taken for advanced testing and treatment.

What Are the Causes of Central Vertigo?

Various factors are among the causes of central vertigo. This condition, particularly seen in older adults, is associated with ischemic events in the cerebellum, brainstem, and vestibular nuclei. It is more common in individuals with vascular risk factors. Acute demyelinating processes may also cause central vertigo in younger patients. Diseases such as multiple sclerosis are examples of these processes.

In addition, vestibular migraine is a type of central vertigo that affects a small percentage of the general population but is characterized by recurrent episodes of vertigo. Diagnosis becomes easier, particularly when it occurs together with typical migraine headaches. Other causes are less common but remain important factors. Conditions such as infections, head and neck trauma, or brain tumors may also contribute to the development of central vertigo.

Medication-induced vertigo should not be overlooked. Certain medications may have the potential to trigger central vertigo in some individuals. Other medications with ototoxic effects may also cause vertigo complaints. This ototoxic effect can be distinguished from central vertigo through diagnostic testing.

Aminoglycoside antibiotics
Macrolide antibiotics
Chemotherapeutic agents (carboplatin)

How Common Is Central Vertigo?

Central vertigo is a health problem that develops due to various causes, and between 10 and 80 cases per 100,000 people are observed each year in the United States. The incidence of the condition varies according to sex. Most cases of vertigo resulting from stroke are associated with ischemic strokes. Approximately 20% of these strokes affect the posterior circulation of the brain. Lateral medullary syndrome, also known as Wallenberg syndrome, is the most common type.

Central vertigo may also result from neurological diseases such as multiple sclerosis:

The annual incidence rate in the United States is between 10 and 80 per 100,000 people.
This condition affects women three times more often than men.

Vertigo may also occur in patients with migraine. While 12% of the adult population experiences migraine, it is not uncommon for this condition to result in vertigo. Migrainous vertigo (vestibular migraine) may frequently progress to PPPD. Therefore, a very detailed vestibular assessment and rehabilitation are required.

Although neuroimaging methods (MRI and CT) generally produce normal results, diagnosis is made through vestibular examinations performed to exclude other possible causes.

How Is Central Vertigo Diagnosed?

The diagnosis of central vertigo requires a careful evaluation process beginning with neurological symptoms.

The patient’s medical history is the first step in evaluating all forms of dizziness. Patients can generally describe their complaints well. During this process, clinicians ask about and evaluate factors such as the symptoms experienced by the patient, their duration, and their intensity.
The patient’s general condition is then observed through a physical examination. Neurological signs are particularly important during this examination.

Assessment of postural stabilization: Romberg, Tandem, Gait, Fukuda, Timed Up and Go, etc.
Assessment of neurological and motor control skills: Dysdiadochokinesia and finger-to-nose tests, etc.

Positional tests, such as the Dix-Hallpike test and Roll test, are performed when peripheral vertigo is suspected and may assist in the differential diagnosis of central vertigo.
Audiological assessment, including hearing tests and immittance measurements, also plays an important role in understanding the potential causes of vertigo. If central vertigo is suspected after these stages, advanced imaging methods are used.
Imaging Techniques: Brain magnetic resonance imaging (MRI) is the preferred method. If MRI is unavailable, computed tomography (CT) may be used as an alternative.

These imaging techniques are critically important for identifying possible causes of central vertigo, such as infarction, tumors, or bleeding. In addition, other imaging methods such as CT angiography and MR angiography may be used when necessary to detect abnormalities in the vertebrobasilar system.

How Is Central Vertigo Treated?

Central vertigo is a serious type of dizziness caused by central nervous system disorders. The treatment process first begins with a detailed medical evaluation. The patient’s condition is examined carefully to ensure accurate diagnosis and intervention. Treatment methods may be determined according to the severity of the patient’s symptoms. In addition to the main treatment, various supportive therapies may be applied to relieve vertigo symptoms. Because every patient’s condition is different, treatment processes are planned individually.

Frequently Asked Questions

Which brain diseases are most commonly associated with central vertigo?

Central vertigo originates from lesions in the brainstem, cerebellum, or nervous system. Stroke, tumors, multiple sclerosis, and migraine are among the most common causes. Therefore, it requires serious evaluation.

What are the main differences between central vertigo and peripheral vertigo?

In central vertigo, dizziness is more persistent and severe, and imbalance is generally more prominent. In peripheral vertigo, short-term attacks triggered by head movements are more common.

Are visual disturbances a common finding in central vertigo?

Yes, double vision, blurred vision, or impaired eye movements are common findings in central vertigo. When these symptoms occur together with balance problems, a central nervous system origin is considered.

Can central vertigo occur as a symptom of stroke?

Yes, sudden-onset vertigo may be the first sign of a brainstem or cerebellar stroke. Emergency intervention is required when dizziness, imbalance, and speech impairment occur together.

What are the risk factors for central vertigo?

Hypertension, diabetes, smoking, atherosclerosis, and advanced age increase the risk of central vertigo. These factors may affect the cerebral vessels and lead to circulatory disorders.

Which tests are used to diagnose central vertigo?

MRI, neurological examination, and balance tests are used in diagnosis. Evaluation of eye movements and reflexes also helps identify vertigo originating from the central nervous system.

How effective are medications in the treatment of central vertigo?

Treatment varies according to the underlying cause. Clot-dissolving medications may be used for stroke, while immune-modulating treatments are used for MS. Symptomatic medications may relieve dizziness but are not sufficient on their own.

Why is rehabilitation important for patients with central vertigo?

Physical therapy and balance exercises support the brain in developing new balance pathways. Regular rehabilitation reduces the risk of falling and increases independence in daily life.

How is central vertigo managed during pregnancy?

Medication use is limited during pregnancy. Therefore, close monitoring, safe balance exercises, and a multidisciplinary approach in high-risk situations are preferred. Diagnosis and treatment planning require special attention.

What is the long-term prognosis of central vertigo?

The prognosis depends on the severity of the underlying disease. Permanent balance disorders may occur after a tumor or stroke, while appropriate treatment and rehabilitation may improve quality of life.

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Dr. Ody. Emel Uğur

Dr. Audiologist Emel Uğur was born in 1982 in Çanakkale. She specialized in Pediatric Audiology, Otologic Disorders, and Vestibular System Disorders, and served for 15 years at the Istanbul Training and Research Hospital. In 2015, she joined the Acıbadem Healthcare Group. She currently works as an Audiologist at the Acıbadem Altunizade Hospital and also serves as a faculty member and program director in the Acıbadem University Vocational School of Health Services Audiometry Program.