Dizziness A Diagnostic Approach American Family Physician The vestibular nuclei, cerebellum, brainstem, spinal cord, and vestibular cortex make up the central vestibular system. central abnormalities cause approximately 25% of dizziness experienced by patients. 45 common central etiologies include vestibular migraine and vertebrobasilar ischemia. patients with central pathology may present with disequilibrium and ataxia rather than true vertigo. however, vertigo can be a vertigo approach k presenting symptom of an impending cerebrovascular event. 46,47. Assessing a patient with vertigo is a diagnostic challenge for the clinician, particularly in the acute setting where symptoms can be extremely debilitating. 1 however, the most common cause of vertigo, benign paroxysmal positional vertigo (bppv), can be diagnosed and often successfully treated within a consultation. The underlying pathology is excess endolymphatic fluid pressure leading to inner ear dysfunction; however, the exact cau...