It is essential to determine at the outset whether the patient’s report of “dizziness” represents light-headedness or true vertigo. When light-headedness is present, patients will report feeling “faint” or light-headed on standing or walking, as if they are about to pass out. Conversely, one may elicit a history of true vertigo by determining that the room or the patient appears to spin or rotate; these latter truly vertiginous symptoms may be positional to the extent that they are precipitated or worsened by head turning or head motion. A history of chronic headache worsening in association with hearing loss suggests a cerebellopontine angle tumor. The sudden onset of headache associated with vertigo, nausea, vomiting, and difficulty standing
or walking should suggest a cerebellar hemorrhage. The major central nervous system illness associated with the sudden onset of vertigo is acute intracerebellar hemorrhage; this entity must be suspected and recognized early to minimize patient morbidity and mortality. Nausea and vomiting are routinely associated with vertigo caused by vestibular neuronitis, labyrinthitis, benign positional vertigo, or Ménière syndrome. Tinnitus, associated with hearing loss, and vertigo suggest Ménière syndrome, especially if the symptoms of vertigo are chronic and episodic.