Table 1

Clinical summary of patients with positional down beat nystagmus and no CNS disease*

PatientPositional findings
NoSexAgeSymptom (history)+ve ManoeuvreTorsion componentLatency, habitAudiovestibular tests imagingDiagnosis
*The nystagmus was transient—that is, adapted, in all patients. This is some times called positioning rather than positional nystagmus.
CP, canal paresis on caloric testing in the light, ≥9%; HL, hearing loss; SNHL, sensorineural hearing loss; BPPV, benign paroxysmal positional vertigo (AC, anterior canal; PC, posterior canal); D-H, Dix-Hallpike positional manoeuvre; Habit, habituation,—that is, attenuation of the nystagmus on repeated positional manoeuvres; FU, follow up; +ve manoeuvre, manoeuvres provoking pDBN.
1M47Positional vertigo (migraine)R+L D-HR shoulderLatency +R CP (16%)R AC BPPV
SagittalhabitR mild SNHLFU: remitting
Normal CTRecurrent
2M46Positional vertigoSagittal onlyR shoulder on VOGLatency + habitNormal Audiovestibular testsR AC BPPV
(not detected clinically)Normal MRIFU: persisted
3F46Positional vertigo (migraine)R+L D-HTors +ve: direction difficult to ascertainNo latencyNormal audiovestibular testsAC BPPV
No full habitNormal MRIFU: normal
4M62Positional vertigo (head trauma)R+L D-HR+L PC BPPV followed by pDBNLatency + habitBilateral high frequency SNHLR+L PC BPPV
Normal vestibular tests(plus pDBN)
5F35Positional vertigo(PC BPPV)R, L, R+L PC BPPV or pDBN (without obvious torsional component)Latency variableR CP (12%)AC/PC BPPV
HabitNormal audio testsFU: recurrent
Normal MRI
6F68Positional vertigo, space phobia (myopathy)R+L D-HNot with pDBN but on one occasion: RLatency + habitNormal audiovestibular testsAC BPPV
horizontotorsionalMRI: involutionalFU: persisted
7W44Spontaneous? and positional vertigoSagittal onlyNot observedLatencyNormal audiovestibular testsAC BPPV
No habitNormal MRIFU: better subjectively
8M33Positional vertigo (L earR+L D-HNot observedNo latencyL conductive HLL AC BPPV
surgery)Habit not testedMRI abnormal middle earFU: unchanged
9M34Spontaneous and movementL D-HHorizontal L obliqueNo latencyL conductive HLAC BPPV
induced vertigo (migraine and L ear surgery)componentHabit not testedCT inflammatory petrous bone changes?Vestibular migraine
FU: improvement
10F78Positional vertigoL D-H (R D-H: eyeNot observedLatency?Bilat High Frequency SNHLAC BPPV
closure due toHabitNormal vestibular testsFU: R PC BPPV
vertigo)Normal CT
11F53Positional and spontaneousR+L D-HNot observedNo latencyMicro DBN (fundus)AC BPPV
vertigo (migraine)Partial habitNormal Audiovestibular testsVestibular migraine
Normal MRIFU: fluctuating
12F52Spontaneous vertigo+ visual disorder (migraine)R+L D-HNot observedNo latencyNormal audiovestibular testsAC BPPV
Habit not testedNormal CTVestibular migraine