Misleading assumptions	Pearl
True vertigo implies an inner ear disorder.	Do not rely on quality of symptoms; focus on timing and triggers.
Vertigo worsening with head movements implies a peripheral cause.	Differentiate triggers from exacerbating factors because head movement could exacerbate central and peripheral causes.
Hearing loss or tinnitus implies a peripheral cause.	With these auditory symptoms present, rule out a central cause before assuming a peripheral cause.
Headache accompanying dizziness implies vestibular migraine.	Be aware that not every headache presenting with dizziness is a vestibular migraine and could indicate vascular pathologies such as an aneurysm.
Strokes causing dizziness or vertigo must also present with limb ataxia or other focal signs.	Findings on the HINTS (head-impulse, nystagmus, test of skew) examination are more specific and sensitive to rule in stroke than presence of limb ataxia or other focal signs.
Young patients have migraine rather than stroke.	Do not overfocus on age and vascular risk factors; consider vertebral artery dissection in young patients.
CT is needed to rule out cerebellar hemorrhage in patients with isolated acute dizziness or vertigo.	Intracerebral hemorrhage rarely manifests as benign dizziness or vertigo.
CT is useful to search for acute posterior fossa stroke.	Recognize the limitations of imaging, especially CT.
A negative diffusion-weighted MRI rules out posterior fossa stroke.	Recognize the limitations of imaging, even diffusion-weighted MRI; consider repeat testing in 48 hours if negative.