Spontaneous nystagmus with an upbeat component: Central or peripheral vestibular disorders?

Abstract

ObjectiveTo determine the topical diagnosis and etiologies of spontaneous nystagmus (SN) with an upbeat component.MethodsWe retrospectively recruited 43 patients with SN with an upbeat component at a university hospital in China from 2020 to 2022. SN with an upbeat component was divided into pure upbeat nystagmus (UBN), SN with a predominant upbeat component, and SN with a non-predominant upbeat component. We analyzed their clinical and neurotologic findings and the final diagnosis.ResultsFourteen (32.6%) of them showed pure UBN, while 29 (67.4%) exhibited SN mixed with an upbeat component, mixed upbeat-horizontal in 15, mixed upbeat-horizontal-torsional in 13, and upbeat-torsional in the remaining one. Pure UBN and SN with a predominant upbeat component were more common in central than in peripheral vestibular disorders [16 (80.0%) vs. 0 (0%), Chi-Square test, p < 0.001]. Central vestibular disorders were diagnosed in 20 (46.5%) patients, peripheral in 14 (32.6%), and undetermined in nine (20.9%) patients. The underlying causes mainly included acute unilateral peripheral vestibulopathy (n = 11), posterior circulation infarction (n = 9), benign recurrent vertigo (n = 4), vestibular migraine (VM, n = 3), and VM of childhood (n = 2).ConclusionSN with an upbeat component can be seen in both central and peripheral vestibular disorders. Pure UBN was a characteristic sign of central vestibular dysfunction. Central vestibular disorders should be highly suspected when patients show pure UBN or SN with a predominant upbeat component.

Digital biomarkers from gaze tests for classification of central and peripheral lesions in acute vestibular syndrome

“…In conclusion, these results are highly encouraging and strongly motivate further investigation into nystagmus biomarkers, such as vertical nystagmus, up and down gaze tests, and wave-shapes which are known to be diagnostically relevant ( 8 , 22 , 23 ). While acknowledging the limitations of our small sample size, these preliminary findings suggest significant potential, with the biomarkers surpassing the performance of features conventionally used in nystagmus analysis, and a baseline machine learning model.…”

Characteristics of spontaneous nystagmus and its correlation to video head impulse test findings in vestibular neuritis

“…Spontaneous nystagmus (SN)—present in a static state with the head upright and looking straight forward without any inducing condition—is common in acute unilateral vestibular dysfunction, which is spontaneous, unilateral and caused by asymmetric hypo-function of the angular vestibulo-ocular reflex (aVOR) ( Wenyu et al, 2017 ; Ling et al, 2023 ). In the diagnosis, treatment, and rehabilitation of vestibular diseases, SN has the following clinical significance as a routine physical examination indication: (1) it identifies a central or peripheral disease based on the fixation inhibition test and changes in the direction and SPV of nystagmus during left and right fixation (Alexander’s law); (2) it indicates the side of the peripheral vestibular lesion.…”