Unidirectional Vestibular Nystagmus

60-yo-man with recurrent vertigo attacks - this video was taken during one of his typical attacks, and shows left-beating nystagmus that stayed left-beating in all directions of gaze, more in left gaze (in accordance with Alexander's Law), and less in right gaze. This pattern is more commonly seen with peripheral, rather than central disturbances. There were no other neurologic or ocular motor findings such as a skew deviation to suggest a central cause. However, the HIT was negative, which did suggest a central localization. Neuroimaging was negative for stroke during this attack, and the patient was subsequently diagnosed with benign recurrent vertigo/migraine variant as the cause of his vertigo attacks. Video shows unidirectional left-beating nystagmus in the acute vestibular syndrome.