How are central causes of vertigo distinguished from peripheral causes?
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On bedside examination, the combination of a normal horizontal head impulse test, direction-changing nystagmus on eccentric gaze, and skew deviation (vertical ocular misalignment) has a high sensitivity and specificity for presence of a central lesion in vertiginous patients. (SOR: B, based on a cohort study.) For imaging, magnetic resonance imaging (MRI) is more sensitive than noncontrast computed tomography (CT) for early detection of central lesions. (SOR: C, extrapolated from a comparison cohort trial that included all stroke syndromes.)
Evidence Based Practice 14(1): 11.