Peripheral | Central | |
Nystagmus | ||
Features (direction and type) | Unidirectional, fast component toward the normal ear; never reverses direction Horizontal with a torsional component; never purely torsional or vertical | Sometimes reverses direction when patient looks in the direction of slow component Can be any direction; note that purely vertical or purely torsional nystagmus is a central sign |
Effect of visual fixation | Suppressed | Not suppressed |
Postural instability | Unidirectional instability, walking preserved | Severe instability, patient often falls when walking |
Deafness or tinnitus | May be present | Usually absent |
Other neurologic signs and symptoms | Absent | Often present (eg, diplopia, ataxia, dysarthria, dysphagia, focal or lateralized weakness) |
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