Reply To: Neurology nystagmus localisation
So the basic principals are…
In peripheral vestibular disease, the nystagmus can be horizontal or rotary and the fast phase is always away from the lesion. In central disease the pathologic nystagmus can be in any plane (including vertical), can change direction with different positions of the head, and the fast phase can be toward the lesion. Therefore, identification of a vertical nystagmus or a nystagmus with the fast phase toward the lesion is an indication of central involvement. However, caution should be exerted when labeling a patient with central disease based on vertical nystagmus alone since it is easy to confound nystagmus with a slight rotary component with vertical nystagmus. One comparative clinical study also suggested that the number of beats of the resting nystagmus was significantly higher in peripheral vs. central disease. A resting nystagmus rate of more than 66 beats per minute was found to be very specific (95%) and sensitive (85%) of peripheral disease.
I have contacted one of our neurology specialists to get a final call location!