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1 Downbeat (perverted) head shaking nystagmus in a patient with spontaneous torsional nystagmusThis is a 75-year-old woman with vascular risk factors who experienced abrupt onset imbalance and dizziness. Symptoms were maximal at onset, and she denied progression over 6 months. Clinically, it was felt that she had suffered a stroke, although an MRI one months later demonstrated an unremarkable...Torsional Nystagmus; Jerk Nystagmus; Headshaking; Downbeat Nystagmus; Cerebellar Pathology
2 Head-Shaking NystagmusHead-shaking nystagmus: With a peripheral lesion, similar to vibration, transiently accentuates vestibular asymmetry when baseline VOR function is asymmetric, central patterns are well described and have localizing value (e.g., causing vertical nystagmus after horizontal head-shaking, horizontal nys...Nystagmus, Head-shaking nystagmus, Exam
3 Head-Shaking-Induced Nystagmus Following Ramsay Hunt VestibulopathyThis is a 50-year-old man who experienced the abrupt onset of imbalance, dizziness and left-sided hearing loss 4 months prior to this examination. He was found to have herpetic vesicles in the left external auditory canal and diagnosed with Ramsay Hunt syndrome. On exam (4 months after the onset), t...Vestibular Nystagmus; Head-Shaking; Jerk Nystagmus; Vestibularcochlear; Acute Vestibular Syndrome
4 Head-shaking nystagmus - a "central" patternEvaluating for nystagmus provoked by head-shaking, so-called head-shaking nystagmus (HSN), should be performed in all patients with complaints of dizziness or vertigo, regardless of the chronicity. The maneuver is performed by passively moving the head horizontally (can also be performed vertically)...Abnormal Head Shaking, Jerk Nystagmus, Vestibular Nystagmus
5 Periodic alternating nystagmus and perverted head-shaking nystagmus in cerebellar degenerationThis is a 60-yo-woman with several years of worsening imbalance, diplopia (hers was actually unrelated to cerebellar pathology [although she did have an esotropia greater at distance that was cerebellar in origin] and due to thyroid eye disease) and blurry vision (due to her spontaneous nystagmus). ...Headshaking, Cerebellar, Jerk Nystagmus, Periodic Alternating Nystagmus
6 Provocative maneuvers (removal of fixation, vibration, head-shaking) to accentuate peripheral vestibular nystagmus)With an acute destructive process like vestibular neuritis that causes significant unilateral vestibular loss, spontaneous nystagmus is always present. However, over days to months, spontaneous nystagmus should resolve completely. In a patient with vestibular neuritis involving the right side, left-...Headshaking Nystagmus
7 Vibration-induced nystagmus in a patient with vestibular neuritisThis is a 60-year-old man who experienced the sudden onset of vertigo, oscillopsia, imbalance, nausea and vomiting. He was seen in the emergency department within hours and had spontaneous right-beating (RBN) and torsional (top poles toward right ear) nystagmus that was unidirectional in all directi...Jerk Nystagmus; Vestibular Nystagmus; Eighth Cranial Nerve; Acute Vestibular Syndrome
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