What is the cause of dizziness with unilateral nystagmus (involuntary eye movement)?

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Last updated: April 28, 2025 • View editorial policy

Differential Diagnosis for Dizziness with Unilateral Nystagmus

Single Most Likely Diagnosis

  • Benign Paroxysmal Positional Vertigo (BPPV): This condition is characterized by brief, episodic vertigo triggered by specific head movements, often accompanied by unilateral nystagmus. It's a common cause of vertigo and can present with dizziness.

Other Likely Diagnoses

  • Vestibular Neuritis: An inner ear disorder that causes inflammation of the vestibular nerve, leading to severe vertigo, dizziness, and nystagmus. It typically affects one ear, resulting in unilateral symptoms.
  • Labyrinthitis: Inflammation of the inner ear's labyrinth, which can cause vertigo, dizziness, hearing loss, and tinnitus. Unilateral nystagmus can be present due to the asymmetric involvement of the vestibular system.
  • Meniere's Disease: A disorder of the inner ear that affects balance and hearing, causing episodes of vertigo, tinnitus, hearing loss, and aural fullness. While it often presents bilaterally, it can start unilaterally, leading to unilateral nystagmus.

Do Not Miss Diagnoses

  • Stroke or Transient Ischemic Attack (TIA): Although less common, a stroke or TIA in the posterior circulation can present with sudden onset of vertigo, dizziness, and nystagmus. It's crucial to rule out these conditions due to their high morbidity and mortality.
  • Posterior Circulation Infarct: Infarcts in the brainstem or cerebellum can cause vertigo, nystagmus, and other neurological deficits. Early recognition is vital for appropriate management.
  • Multiple Sclerosis: This demyelinating disease can present with a wide range of neurological symptoms, including vertigo and nystagmus, especially if there are lesions in the brainstem or cerebellum.

Rare Diagnoses

  • Acoustic Neuroma: A benign tumor on the vestibulocochlear nerve can cause unilateral hearing loss, tinnitus, and balance problems, including vertigo and nystagmus.
  • Superior Canal Dehiscence: A rare condition where there's an abnormal opening in the bone overlying the superior canal of the inner ear, leading to vertigo and nystagmus in response to sound or pressure changes.
  • Perilymphatic Fistula: An abnormal connection between the inner and middle ear, which can cause vertigo, hearing loss, and nystagmus, often after trauma, surgery, or barotrauma.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.