On videonystagmography (VNG), a patient demonstrates direction-changing nystagmus that increases in amplitude with gaze in that direction. This pattern is consistent with which type of nystagmus?

• A Peripheral spontaneous nystagmus following a fixed direction
• B Gaze-evoked nystagmus suggesting central vestibular or cerebellar lesion ✓
• C BPPV nystagmus with Dix-Hallpike positioning
• D Rebound nystagmus from alcohol intoxication

Explanation

Direction-changing nystagmus with Alexander's law (nystagmus increases in the direction of the fast phase) that changes direction with gaze (right-beating on right gaze, left-beating on left gaze) is called gaze-evoked nystagmus and is a sign of central vestibular or cerebellar pathology (typically cerebellar or brainstem lesion affecting the gaze-holding neural integrator). Peripheral spontaneous nystagmus fixes in one direction and is suppressed by fixation. BPPV nystagmus is position-dependent and transient.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.