On videonystagmography (VNG), a patient with acute vertigo shows spontaneous horizontal nystagmus that is suppressed by visual fixation, beats away from the affected ear, and is direction-fixed. These features indicate:

• A Peripheral vestibular lesion (acute unilateral vestibulopathy) ✓
• B Central vestibular lesion (cerebellar stroke)
• C Benign paroxysmal positional vertigo
• D Bilateral vestibulopathy

Explanation

Peripheral vestibular nystagmus is direction-fixed (beats in one direction regardless of gaze), typically horizontal-torsional, and is suppressed by visual fixation due to intact central gaze-holding and fixation suppression mechanisms. In central vestibular disease (e.g., cerebellar stroke), nystagmus may change direction with gaze, may be purely vertical or torsional, and is NOT suppressed by fixation. BPPV nystagmus is positional, not spontaneous.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.