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So once pattern of vertigo (mis-perception of movement) has been distinguished from other kinds of dizziness, there is still more figuring to do—-is problem in brain (central pattern) or in inner ears and their connecting nerves (peripheral pattern)?

Luckily, central and peripheral vertigos can usually be distinguished from each other based on clinical history and physical exam. The key is in looking for any symptom or physical abnormality that can't be blamed on vestibular system.

How about nausea, vomiting, unsteadiness, walking into walls, blurred vision or even jumping vision? A malfunctioning vestibular system could easily account for them all. But double vision, slurred speech, weakness or numbness on one side of body? No way. These symptoms would have to be generated outside of balance system, and imply that other pathways in brainstem are damaged.

Where does MRI scan fit in? The MRI is good at seeing areas of abnormal growth or damage within brainstem, as from tumors, strokes or multiple sclerosis. It can also see tumors that arise from nerves connecting brainstem to inner ears. But that's about all it can see that is at all related to symptom of vertigo.

However, there are far more cases of peripheral vestibular disease than of central (brain-based) disease causing vertigo, so that's why most MRI scans turn out negative. In short, MRI is normal, but patient isn't.

So what can cause peripheral vestibular disease? The causes are varied, but are more usually annoying than life-threatening. The most explosive form of peripheral vestibular disease is vestibular neuronitis or "inner ear attack." The typical story for this condition is that person awakes with violent spinning, nausea and inability to walk a straight line. This condition is at its worst on first day, gradually improving over subsequent days and weeks.

Another peripheral vestibular condition is Meniere's disease in which recurrent bouts of vertigo occur in conjunction with deafness and "roaring" tinnitus, or ringing in ear. This is due to high fluid pressure within inner ear which is also wired for hearing.

Yet another peripheral vestibular disease involves a stone (otolith) rattling around within canals of an inner ear. This variety can sometimes be fixed by "vestibular repositioning" in which patient's head is put through a series of abrupt position-changes designed to make otolith stick in one place.

Medications can also be useful in diminishing symptom of vertigo. The most widely used drug is meclizine (brand name Antivert) which is related to antihistamines and helps simmer down an overactive inner ear. A second drug used in same way is scopolamine, usually delivered via a patch on skin (Transderm Scop). Finally, diazepam (Valium) can also be used a "vestibular suppressant" though is usually last choice owing to its possibility of becoming habit-forming.

And how about those other forms of dizziness that involve lightheadedness, wooziness or giddiness? As a baseball player might say, "That's a whole other ball game."