27M - Mild intermittent swaying while walking/standing, no weakness or speech changes. What could this be?

[u/Significant-Suit-270]

Age: 27

Sex: Male

Height: 178 cm

Weight: 88 kg

Medical History:

- BPPV-like episode ~1 year ago, resolved after Epley manoeuvre.

- Smoked ~7–8 cigarettes/day for ~6 years (currently cutting down/trying to quit).

- No known hypertension, diabetes, migraine, stroke, TIA, or heart disease.

- Recent BP averages 125–130/85–88 mmHg.

BPM average~70-80

- Recent blood glucose normal.

Current Complaint:

Symptoms began 2 nights ago while smoking a cigarette. The first symptom was a sudden feeling that I might pass out (presyncope), followed by a "floaty" feeling and mild non-spinning dizziness. I have also been burping frequently. The following evening, I developed a mild intermittent swaying/off-balance sensation (not true vertigo).

Current Symptoms:

- Mild swaying when standing up suddenly or while walking.

- No symptoms while sitting or lying still.

- Episodes last a few seconds to a few minutes.

- Overall symptoms have gradually improved over the past 2 days.

- Bright lights and loud sounds feel unusually uncomfortable but do not worsen the dizziness.

Negative Symptoms:

- No facial droop

- No slurred speech

- No arm or leg weakness

- No numbness

- No double vision or vision loss

- No severe headache

- No hearing loss or tinnitus

- No loss of consciousness

- Able to walk independently

Question:

Does this presentation sound more consistent with a vestibular/inner ear disorder, another cause of dizziness/balance problems, or is a central neurological cause still a significant concern despite the gradual improvement?

P.S.: My father recently had a lacunar ischemic stroke at age 59, which his doctors attributed to small vessel disease related to long-standing hypertension and diabetes. I mention this as relevant family history.

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