Which finding supports peripheral vestibular disease rather than central nervous system disease?

• A. Head tilt with horizontal nystagmus and normal mentation
• B. Vertical nystagmus with mentation changes
• C. Seizures
• D. Cranial nerve deficits

Answer: (A)

Differentiating peripheral from central vestibular disease relies on the pattern of signs. Peripheral vestibular disease typically causes a head tilt toward the affected side and spontaneous horizontal (or rotary) nystagmus with the fast phase away from the lesion, all while mentation remains normal because the brain itself isn’t involved.

The combination of a head tilt with horizontal nystagmus and normal mentation fits this pattern best, pointing to a peripheral origin in the vestibular apparatus or nerve. In contrast, vertical or direction-changing nystagmus, mentation changes, seizures, or cranial nerve deficits tend to indicate central nervous system involvement, where brain structures are affected.