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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