On videonystagmography, the head shake test is performed by oscillating the patient's head horizontally 20-30 times at 2 Hz. A positive response with post-head-shake nystagmus beating to the left suggests which pathology?

• A Bilateral vestibular loss
• B Left peripheral vestibular hypofunction (compensated phase)
• C Right cerebellar hemisphere lesion
• D Right peripheral vestibular hypofunction (compensated phase) ✓

Explanation

After head shake, nystagmus beats away from the side with the greater vestibular activity. If the right ear is hypofunctional, the left side is relatively dominant after stimulation, producing left-beating nystagmus. This is seen in compensated unilateral peripheral lesions. Bilateral loss produces no response. Cerebellar lesions do not produce this specific post-head-shake pattern.

Reference: Baloh and Honrubia's Clinical Neurophysiology of the Vestibular System, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.