Case 11 · clinician

Stroke patient who resists being made upright

Vignette

A 72-year-old man is 5 days into rehabilitation after a right hemispheric ischaemic stroke. He has a left hemiparesis and left hemispatial neglect. When seated, his trunk lists 15° to the left, and he pushes hard against the therapist's attempts to correct it, insisting he is upright. Bedside bucket SVV (visual vertical) is +0.5°. When passively tilted in a chair with eyes closed and asked to indicate when he is upright, he consistently calls upright at a position 13° tilted to the left.

SVV trace

+0.5° ± 1.2°

Visual SVV near-normal; postural vertical grossly tilted

Which condition does this dissociation indicate?

← Persistent dizziness six months after vestibular neuritisAll casesOscillopsia and unsteadiness after months of IV gentamicin →
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.

© 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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