A 59-year-old reports vertigo triggered by lying down and rolling over. On positional testing the nystagmus begins immediately with no latency, is purely downbeating, does not fatigue on repetition, and persists as long as the position is held. There is no ear symptom.

Affected earContralateral ear

Peripheral VEMP pathways are intact; the figure underscores that the abnormality here is not an otolith-organ deficit.

Which feature of this positional nystagmus most strongly indicates a CENTRAL rather than a BPPV (canalith) cause?

Select an option to continue.

← All clinical cases

Affected earContralateral ear

Peripheral VEMP pathways are intact; the figure underscores that the abnormality here is not an otolith-organ deficit.

Which feature of this positional nystagmus most strongly indicates a CENTRAL rather than a BPPV (canalith) cause?

Select an option to continue.

← All clinical cases

Positional vertigo that does not behave like BPPV

Which feature of this positional nystagmus most strongly indicates a CENTRAL rather than a BPPV (canalith) cause?

Positional vertigo that does not behave like BPPV

Which feature of this positional nystagmus most strongly indicates a CENTRAL rather than a BPPV (canalith) cause?