Case 04 · trainee

Imbalance with normal HIT in a 71-year-old

Vignette

A 71-year-old man with breast cancer (treated five years ago) presents with progressive unsteadiness over three months. He has gaze-evoked nystagmus in all directions, impaired smooth pursuit, and a wide-based gait. Head impulse test is normal. Bucket SVV mean is −1.5°. Standard deviation across 10 trials is 4.2°.

SVV trace

-1.5° ± 4.2°
SVV finding

Mean within normal limits, SD grossly elevated

What does the SVV pattern suggest?

← Diplopia and head tilt after a small midbrain bleedAll casesAutophony and a near-normal SVV →
Subjective Visual Vertical

An interactive teaching atlas of Subjective Visual Vertical for the assessment of otolith-graviceptive function — bucket and digital technique, dynamic SVV, normal findings, and the tilt signatures of peripheral and central vestibular disease. Content synthesised from current Bárány Society criteria, peer-reviewed vestibular literature, and standard otoneurology texts.

→ Full references & acknowledgements
Built for

Medical students, ENT / Neurology / Audiology trainees, vestibular therapists, and clinicians who want to teach themselves the language of vertigo.

Concept & design
Dr Prahlada N.B

Karnataka ENT Hospital and Research Centre (R),
Champions Educational and Medical Society (R),
Amogh Foundation, Chitradurga, Karnataka, India

Please share your valuable feedback to:
prahladnb@kenthospitals.com

Disclaimer

For educational purposes only. Not for clinical use. The Subjective Visual Vertical chapter is an instructional resource intended to support learning about SVV and the assessment of otolith-graviceptive function. Clinicians remain completely responsible for the interpretation of findings, the formulation of a differential diagnosis, and any clinical decision. Nothing in this application replaces individualized assessment, hands-on training, expert consultation, or established practice guidelines.

A publication of
© 2026 Dr Prahlada N.B · Karnataka ENT Hospital and Research Centre (R) · Champions Educational and Medical Society (R) · Amogh Foundation, Chitradurga, Karnataka, India
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