On videonystagmography (VNG), a patient shows a direction-changing gaze-evoked nystagmus that reverses with gaze direction and is suppressed with visual fixation. This pattern is most consistent with:
- A Central (gaze-holding) nystagmus from a cerebellar lesion ✓
- B Unilateral peripheral vestibular hypofunction
- C Benign paroxysmal positional vertigo
- D Bilateral vestibular failure
Correct answer: A. Central (gaze-holding) nystagmus from a cerebellar lesion
Explanation
Direction-changing gaze-evoked nystagmus (DCGN), where nystagmus beats towards the direction of gaze and reverses when gaze is shifted to the opposite side, is a classic central sign indicating a cerebellar or brainstem lesion (failure of the gaze-holding neural integrator). Peripheral vestibular nystagmus is unidirectional and suppressed by fixation. BPPV is positional, not purely gaze-evoked, and bilateral failure causes oscillopsia rather than gaze-evoked nystagmus.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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